INFORMATION SESSIONS

SYDNEY

Sunday 18 September 2011
Time: 2pm
Venue : Sydney Jewish Museum, Auditorium, 148 Darlinghurst Road, Darlinghurst

MELBOURNE

Sunday 11 September 2011
Time: 7pm
Venue: Jewish Holocaust Centre, 13 Selwyn Street, Elsternwick

Dates FOR MOTL 2012

Sunday 15 April - Tuesday 1 May 2012

Interview Date

Sunday 6 November 2011

Shabbaton Dates

To be held in Melbourne
Friday 10 Feb - Sunday 12 Feb 2012

Staff/Madrich Registration

Last Name:

First Name:

Name as per passport:

Gender:

Male
Female

Photo - head and shoulders only (does not need to be passport):

Upload:

Address Line 1:

Address Line 2 (if required):

Suburb:

State:

Country:

Post Code:

Home Phone:

Mobile Phone:

Email - please ensure this is a current email that you use as alot of email correspondence takes place:

Alternate Email:

Date Of Birth:

Passport Number:

Passport Nationality:

Passport Expiry Date:

Private Health Insurance:

Policy Number:

Medicare Number:

Spouse Name (if applicable):

Spouse Mobile:

Spouse Email:

Parents name (for madrichs):

Home contact number if different to above:

Father's Mobile:

Mother's Mobile:

Best parent contact email:

Employer Name (if applicable):

Employers's Contact Number:

Emergency contact other than spouse or parents as listed above (optional):

Relationship to applicant:

Contact Number (Home):

Contact Number (Mobile):