Tel. (972) 2-571-5112      Email: office@refuah.net

Finding Your Soulmate Course Registration

Name: Salutation First Name Last Name Address: Street and Number City Zip Code E-mail: Age: Preferred way to receive material: Email Mail Fax Gender: Male Female Tel: Home Work Fax / Cell Marital Status: Single Separated Married Divorced Engaged Profession / Career: Shadchan Counselor Mentor Rabbi Rebbetzin Educator Other I wish to take the 4-week course starting Sunday, March 5 - March 26, 2006 Tuition: only $ 199 Or Register by Email, office@refuah.net, or by calling us at 972-2-571-5112

REFUAH INSTITUTE     Tel. (972) 2-571-5112   Fax (972) 2-587-9557    Email: office@refuah.net