Agudas Chassidei Chabad-Lubavitch Global Farbengen Initiative Community Leader Registration Form
Name *
Street Address *
State/Prov *
Zip/Postal Code *
Country *
Cell Phone *
Home Phone *
Fax *
Email address *
Head Shaliach *
City of Head Shaliach *
Regional Shaliach *
City of Regional Shaliach *
Community Farbrengen (Men)
School, shul or venue where Farbrengen will take place
Anticipated attendance
Community Farbrengen (Women)
Elementary School (Boys)
Elementary School (Girls)
High School (Boys) Farbrengen
High School (Girls) Farbrengen
Farbrengen for Regional Shluchim
