| SECTION
1 – Personal Data |
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First Name |
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Last Name |
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Mailing Address |
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City |
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State/Province |
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Zip/Postal Code |
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Country |
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Time Zone |
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Office Tel. |
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Home Tel. |
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Cell |
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E-mail |
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| SECTION
2 – Personal Information |
| We would like to know a little
about you and your spiritual orientation, so we can support you
more effectively as you go through the course. We’ll keep
this information strictly confidential. If you prefer not to
answer a particular question, put “N/A”. The form
won’t go through unless each box is filled in. |
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1. Are
you new to Mussar? If not, please explain briefly what form of
study or readings you have done previously.
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2. How did you hear about this
program?
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3. What is the most recent
program in Jewish learning in which you participated?
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4. What do you hope to get
out of Everyday Holiness?
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5. What date will you begin
the program?
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6. We may be able to give you
a chevruta (study partner) within driving distance. What is the nearest large city to where you live, how many miles/kilometers away is it and what is the time zone?
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| 7. If 4 or more people register
as a group in a local area, we will provide you with discussion
questions for each lesson. The requirements are that: |
- At least 4 people register at the same time.
- One person
is designated as the group contact for administrative matters
such as receiving the discussion questions and providing them
to the other members.
- Each member lists the names of the group
members in this form.
- You specify how often you will meet (not
less than every two weeks, not more than every three weeks).
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| If you are signing up as part
of a local group (what is called a Mussar va'ad), please check
the box:
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If you checked this box,
please list the names of the members of the group in the box
below.
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| Please be aware that the clock
on your course will not start until you or a representative of
your va'ad informs us that the va’ad members
are all ready to begin. At that time, you will be assigned a chevruta partner
and sent the information you'll need to get started in the course.
Please note that The Mussar Institute is not responsible for
organizing or managing the va’ad, and we urge you
to choose one member to be the va’ad leader
to take that role. |
| 8. What is your age? |
| 9. What is your marital status?
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| 10. What is your gender?
Male
Female |
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12. Do you have any hindrances
to talking on the telephone for an hour once a week (e.g., physical
handicaps)?
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13. Do you have any concerns
about your ability to complete the program?
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14. If you are Jewish, which
denomination(s) would you say most closely describes you?
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16. If your primary affiliation
is to a religion other than Judaism, or if you do not have a
religious affiliation, please note your spiritual orientation
here.
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| SECTION
3 – Payment |
 In order to keep administrative
costs low, the only payment we can accept
is via PayPal. This
is a fully secured site which accepts major credit cards.
When
you have completed the PayPal form, please
close that window only, being careful not to close out of the
whole website, and return to this window so you can submit this
form. Without doing
so, your registration form will not be automatically be submitted
to TMI. |
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Canadian Residents:
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US Residents:
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Australian Residents:
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Materials FOR PERSONAL USE only |
| I understand that the materials
I receive in this program are copyrighted and are made available
to me for my personal use only. By making payment and registering
for this program, I affirm that I will not circulate them, post
them to websites, or distribute them in any way, nor give access
to the CourseSite of the materials to any other people. |
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| Refund
Policy |
For withdrawal within the first
two weeks after registration: 50% refund.
For withdrawal after
the first two weeks after registration: no refund.
If you withdraw
and decide to re-enroll at a future time, the full fee will be
payable at that time. |
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Please note: One "hiatus"—i.e., a break of up to three months—in the course, is permitted. At the end of the hiatus, a fee of 50% of the ordinary fee is payable for re-registration in order to pick up the course again. A break of more than three months, or a request for a second hiatus, will be considered dropping out of the course. The fee for re-registration after dropping out of the course is 100% of the course fee. |
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Questions or comments:
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