Study Group Request Form

Brandeis National Committee - San Fernando Valley Chapter

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MAIL IN STUDY GROUP REQUEST FORM

PRINT, FILL IN PRINTING LEGIBLY, MAIL TO ADDRESS AT THE BOTTOM
USE ONE REQUEST FORM FOR EACH GROUP


Date___________________

Group Title____________________________________________________Group Number____________

Meeting day and week _________________________________________Time______________________

Name_____________________________________________Home Telephone_____________________

Address________________________________________ City_______________________Zip_________

Email _____________________________________________________FAX ________________________


Comments and Suggestions: [Use other side if necessary]


Please return this STUDY GROUP REQUEST FORM TO THE FOLLOWING:

Book Groups:  Ethel Kaplan    24116 Killion St.   Woodland Hills, CA 91367    818-346-6230

Movie Groups:  Rosemary Rubin    5200 White Oak Ave #40    Encino, CA 91346    818-783-1364

On the Town Groups:  Sharon Heller    6000 Fenwood Ave.    Woodland Hills, CA 91367    818-884-3368

All other numbered groups:  Rosemary Rubin    5200 White Oak Ave #40    Encino, CA 91346    818-783-1364

All Pending Groups:  Evelyn Perl    4839 Rubio Ave    Encino, CA 91436    818-905-5393


For further questions or information: - Evelyn Perl    eperl@mindspring.com    818-905-5393



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