Celebrating Change-Makers

Thank you for your RSVP to Celebrating Change-Makers. To reserve your space, please fill out the registration information below.

Celebrating Change-Makers
Thursday, October 20, 2016
6:00-7:00 PM: Supper in the Sukkah
7:00-8:30 PM: Program and Dessert

Please RSVP by October 14th.

Location: Private residence on the Upper West Side (we will send you the address once you have registered)

Dietary laws observed.

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* 1. Title:

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* 2. First Name:

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* 3. Last Name:

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* 4. Email address:

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* 5. Second guest's name:

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* 6. Second guest's email address:

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* 7. Phone Number:

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* 8. Address:

Address Line 1:

Address Line 2:

City:

State:

ZIP:

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* 9. How did you hear about this event? (If from a specific person, please list that person's name)

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* 10. How would you like your name to appear on your nametag?

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* 11. Please list other guests, additional comments, or accessibility needs here.

Please email us at changemakers@joinforjustice.org with any questions.