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

Student Registration

Last Name:

First Name:

Name on Passport:

Gender:

Male
Female

Photo for ID Tags - Front facing, Head & Shoulders only (doesn't need to be passport photo), JPEG only:

Upload:

Address Line 1:

Address Line 2 (if required):

Suburb:

State:

Country:

Post Code:

Home Phone:

Mobile Phone (Students Phone):

Email (Student) - please ensure this is a current email that you use as a lot of email correspondence takes place:

Date Of Birth:

Passport Number:

Passport Country:

Passport Expiry Date:

Private Health Provider (if applicable):

Private Health Provider Policy Number:

Medicare Number:

Father's Name:

Father's Phone (if different to Home Phone):

Father's Mobile:

Father's Email:

Father's Occupation:

Mother's Name:

Mother's Phone (if different to Home Phone):

Mother's Mobile:

Mother's Email:

Mother's Occupation:

Emergency Contact Name (other than parents):

Relationship to Student:

Emergency Contact's Phone:

Emergency Contact's Mobile:

School:

Principals Name:

Year Level Co-ordinators name:

School Phone:

Why do you want to participate on MOTL ?:

What do you hope to contribute to MOTL and the group?:

How do you see yourself contributing to the Jewish Community ?: