Brandeis National Committee - San Fernando Valley Chapter



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ON-LINE STUDY GROUP REQUEST FORM

COMPLETE AND SUBMIT A SEPARATE REQUEST FORM FOR EACH STUDY GROUP

Date

 

Study Group Title

Study Group Number

Meeting Day and Week

Meeting Time

Name (last name first)

 

Preferred Telephone

Other Telephone

Address: Street

 

Address: City

Address: Zip code

Email address

 

repeat Email address (for accuracy)

 

Comments and suggestions


Please check the information above carefully for accuracy
 

For further information email Evelyn Perl at: eperl@mindspring.com