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* 1. Which Tikun Workshop are you interested in booking?

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* 2. Would you like to book a speaker with lived experience of poverty and homelessness as well?

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* 3. Organization name (if applicable)

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* 4. Full name of contact person:

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* 5. Contact phone number:

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* 6. Contact email address:

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* 7. Have you hosted a tikun workshop or Ve'ahavta speaker before?

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* 8. What motivated you/your organization to invite Ve'ahavta to run an educational program?

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* 9. What date and time are you requesting for the event?

Date / Time

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* 10. Please provide an alternative date and time.

Date / Time

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* 11. Please provide a second alternative date and time.

Date / Time

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* 12. Please describe the group who will be participating in the workshop (size of group, school/camp background, group dynamics, coed or not, familiarity with Ve'ahavta, etc).

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* 13. If you are interested in your group further engaging with Ve'ahavta please select any of the following options you want to learn more about:

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