Enrollment form for conversion course
Long Distance Conversion-to-Judaism Program
Return this form via email to rabbi@jconversion.org  
Today’s Date:
Name:                                                              Date of Birth:
Gender Male or Female?   If male, are you circumcised?

Phone:                                                              Email:

Mailing address

Name of Spouse (if applicable):                      

 Is your spouse/partner Jewish already?  Or converting also?

Names(s) and ages of Children: Indicate if they are converting and if not, why not:

How did you learn about the program? 

Please briefly explain your interest in converting to Judaism: Tell us anything about your educational history, present/past religious affiliation, family or   personal situation you think we should know.  (The final essay              will ask for more  detail). This is confidential and will only be read and shared with the beit din.

             Read and put initials here    
                 ___I/we understand that any conversion may not be acceptable to some Rabbis
                 and  the Israeli Orthodox  Rabbinic establishment.

                __I/We do not accept Jesus/Yeshua as our Lord and savior,
                or messiah.

             Describe any prior Jewish learning. If you have previously
             worked with a rabbi, include  name and contact info:
PAYMENTHow to Purchase books and pay tuition for the course

                       ______ I adult converting$495. You buy the books
                       ______Or I want you to buy and ship all materials within USA $595
                       ______Or I live outside the USA and want you to send all materials $640
                    _______# of people besides you who is converting 18 and older 50% discount
@$250 each additional person (If you have a partner who is Jewish, we strongly encourage them to take
the course with you, but no extra charge for him/her.


Pay for course and materials with credit card or ask for paypal request
Credit card  #--------------------------------------------------------------------
Expiration date______________________
Security code on back__________________________

 We very much look forward to working with you!


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