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College Connection Form

Please complete the following form.

Student's Name
School Name
Street Address
City
State
Zip Code
Email Address
Birthday
Graduation Year
Major
Cell Phone Number
Winter Break Dates
Spring Break Dates
	Please include us as sponsors If you would like to be included as a sponsor, please check this box and mail a check for $18, payable to: Temple Beth Sholom Men's Club. Alternately, please make a donation using our online donation system.