Hillel JUC - Contact Information Form

Contact Information Form For Students

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* required information

* I Am a(n)
* First Name
* Last Name
* Birth Date	(mm/dd/yyyy)	* Email Address
* University / College
* Graduation Year		* Major / Department
* Phone Number		AIM / MSN Messenger Screen Name
* Campus Address (Line 1)
Campus Address (Line 2)
Campus City
Campus State		Campus ZIP Code
Mother's First Name		Mother's Last Name
Mother's Email Address
Father's First Name		Father's Last Name
Father's Email Address
* Permanent Address (Line 1)
Permanent Address (Line 2)
* Permanent City
* Permanent State		* Permanent ZIP Code
Permanent Phone Number
Your Interest Area(s)	Hillel JUC Student Groups Brotherhood First Year Students of Hillel (FYSH) Hillel JUC CMU Student Board Hillel JUC Pitt Student Board Jewish Greek Council (JGC) Jewish Studies Program @ Pitt (CMU students may enroll in the Program's courses) KESHER – Connecting Reform Jews on Campus Kosher Food on Campus Religious Education Shabbat and Holidays Sisterhood Social Justice STAND: A Student Anti-Genocide Coalition Twentysomethings And Graduate Students (TAG) Yiddish Club Israel Alumnus of FREE Taglit-birthright israel: Hillel trip FREE Taglit-birthright israel: Hillel trip Hebrew Conversation Israel on Campus (IOC) Israel Study Abroad Middle Peace Other Israel Travel Opportunities Panthers for Israel Session: Middle East Tartans for Israel
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4607 Forbes Avenue, Pittsburgh, PA 15213 · 412-621-8875 · info@hilleljuc.org

The Edward and Rose Berman Hillel Jewish University Center of Pittsburgh
is a beneficiary agency of the United Jewish Federation of Pittsburgh