Bais Chana goes to Crown Heights, NY!Session 1: Sept 16-19, 2024, Mon-ThuSession 2: Sept 19-22, 2024, Thu-Sun Page 1 Contact Information First Name Last Name Cell Phone Home Phone Email Date of Birth (mm/dd/yyyy) mm/dd/yyyy x Permanent Address Street City U.S. StatePlease select... AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY PR VI Northern Mariana Islands Guam American Samoa Palau Postal Code CountryPlease select... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe State/Province if OUTSIDE of the United States Session 1: Monday - Thursday, Sept 16-19Session 2: Thursday - Sunday, Sept 19-22For each 3-day session, including all classes, workshops, meals, you'll get to choose your price between $540 - $900. Overnight accommodations, where needed, will be charged separately. Will you be joining us for one session or both?Joining only one session (3 nights)Joining both sessions (6 nights)Other (joining individual days, classes or meals) Which days, classes or meals will you be joining? Which session will you be joining?Session 1: Monday - Thursday, Sept 16-19Session 2: Thursday - Sunday, Sept 19-22 Page 3 Choose your accommodations We'll be staying together in a lovely condo complex, just a short walk to the the heart of Crown Heights with its many shops and restaurants. Each condo is fully equipped with modern amenities and a kitchenette. You'll be staying in one of two kinds of condos. Either a 4 bed/1 bathroom condo, or a 7 bed/2 bathroom condo. Preferences will be honored on a first come first served basis. You may also choose to book a private condo all to yourself. Options are available to extend your stay before and after the retreat. See below. Choose your program fee$540 Discounted Rate (Available for shared rooms, Queen Sofa and Hi-Rise accommodations. Not available for private room or private condo). $720 Full Rate$900 Full Rate Plus. This includes a donation to help another woman come at a discounted rate. The Program Fee includes all classes, workshops and meals for your full 4-day, 3-night Bais Chana retreat and a trip to the Rebbe's Ohel. (If you intended to sign up for both sessions, 6-nights, please go back to the previous page and choose "both sessions".) Choose your accommodations for your 3-night stayI'll arrange my own sleeping accommodations.Shared room at "My Crown Stay" Condos: + $210 ($70/night)Private room in a shared condo: + $420 ($140/night)Private condo: + $840 ($280/night)If you're flexible, and open to sleeping in your condo common space (pics 1 and 3 above), take advantage of the options below. You'll be upgraded to a bedroom automatically based on availability. Queen sofa bed in the condo's common space: + $195 ($65/night)Hi-Rise bed in the condo's common space: + $180 ($60/night) Additional NightsDo you plan on arriving a day early or staying on an extra night? Each 1-bedroom condo at My Crown Condos costs $200/night and has 4 beds; 2 in the bedroom and 2 in the common area. For additional nights before or after the retreat, the condo price will be split equally between the number of guests that sign up for that night. The earlier you sign up, the greater the likelihood of having other women to split the condo with. These requests will be filled on a first come basis and are based on availability. Please let us know if you're interested in booking additional nights. Additional accommodationsI don't need additional nights.I need additional night(s) before the retreat. I need additional night(s) after the retreat. Which additional nights do you need? (add any additional comments here) To share room with a specific friend or friends, please provide their name/s. Share room 1 Share room 2 Share room 3 Page 3 Choose your accommodations The group will be staying together in a lovely condo complex in Crown Heights with brand new comfortable beds, balconies, and convenient, modern amenities. You'll be staying in one of two kinds of condos. Either a 4 bed/1 bathroom condo, or a 7 bed/2 bathroom condo. Preferences will be honored on a first come first served basis. You may also choose to book a private condo all to yourself. Options are available to extend your stay before and after the retreat. See below. Choose your program fee$1080 Discounted Rate (Available for shared rooms, Queen Sofa and Hi-Rise accommodations. Not available for private room or private condo). $1440 Full Rate$1800 Full Rate Plus. This includes a donation to help another woman come at a discounted rate. The Program Fee includes all classes, workshops and meals for your full 7 day, 6-night Bais Chana retreat and a trip to the Rebbe's Ohel. (If you intended to sign up for only one 3-night session please go back to the previous page and choose which session.) Choose your accommodations for your 6 night stayI'll arrange my own sleeping accommodations.Shared room at "My Crown Stay" condos: + $420 ($70/night)Private room in a shared condo: + $840 ($140/night)Private condo: + $1680 ($280/night)If you're flexible, and open to sleeping in your condo's common space (pics 1 and 3 above), take advantage of the options below. You'll be upgraded to a bedroom automatically based on availability.Queen sofa bed in the condo's common space: + $390 ($65/night)Hi-Rise bed in condo's common space: + $360 ($60/night) Additional NightsDo you plan on arriving a day early or staying on an extra night? Each 1-bedroom condo at My Crown Condos costs $200/night and has 4 beds; 2 in the bedroom and 2 in the common area. For additional nights before or after the retreat, the condo price will be split equally between the number of guests that sign up for that night. The earlier you sign up, the greater the likelihood of having other women to split the condo with. These requests will be filled on a first come basis and are based on availability. Please let us know if you're interested in booking additional nights.. Additional accommodationsI don't need additional nights.I need additional night(s) before the retreat.I need additional night(s) after the retreat. Which additional nights do you need? To share room with a specific friend or friends, please provide their name/s. Share room 1 Share room 2 Share room 3 Page 4 Tell us about yourself Relationship Status:Relationships are such an important part of our lives. At Bais Chana you'll find answers to your most pressing relationship questions and dilemmas, and secrets that will strengthen even the best relationships! Please select... Single Dating Married Widowed Divorced Other Please explain. What are you most looking forward to at the retreat? What topics are you most interested in hearing about? Have you ever attended a Jewish learning program or retreat? If so, please list when and what. What do you hope to gain by attending? Are you converting?Please select... Yes No Who is your conversion Rabbi? (Please provide a name and contact information.) Hebrew name, if known Mother's Hebrew name, if known Page 5 Important Information Do have any dietary needs or restrictions? Please be as specific as you can so we have what you need. If the answer is no, write no. Do you have any allergies, including penicillin? If the answer is no, write no. Significant medical history, if so, explain. If the answer is no, write no. Will you be taking any medications when you're with us? If so, please list. If the answer is no, write no. Emergency Contact Information Contact Name Phone Relationship to You Additional comments? Anything else you'd like us to know about you? How did you hear about this retreat? Please check all that apply.FriendFamilyFacebookOnline searchRabbi or RebbetzinOnline calendar listingSynagogue or Chabad HouseI'm a Bais Chana Alum!Other Family/Friend Who Introduced you to Bais Chana Referral First Name Referral Last Name Referral Phone Referral Email Add another referral name?Yes, please Ref 2 First Name Ref 2 Last Name Ref 2 Phone Ref 2 Email Please explain. Media Permission I give permission to Bais Chana Women International) to use photos, written quotes, audio or video of me in their promotional materials and for other non-profit purposes. Please select... Yes No Submit your registration by clicking "Next". You'll be redirected to the payment page. Contact Information