- OU Women

Each attendee is requested to complete this form individually (even if the mikvah will be sponsoring her attendance) in order to secure her reservation.

Name(Required)

First Last

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

I currently work as a:(Required)

Mikvah attendant

Mikvah administrator

Mikvah educator

Please check all that apply

Name of Mikvah(Required)

Number of years I have worked at this mikvah(Required)

Please describe your mikvah educator role and list the names of the mikvaos with whom you work (if applicable)(Required)

Previous Mikvah Attendant Positions

Name of Mikvah

City

Years

Click the + sign to add additional names.

Have you previously had any formal Mikvah attendant or sensitivity training?(Required)

Yes

Please elaborate:(Required)

Organization/ Presenter Name

Date

Our workshop facilitators will be using real-life scenarios as examples. If you have a personal anecdote pertaining to a challenging circumstance encountered within the Mikvah context, please share it below. This may include situations that you effectively managed or areas in which you identify opportunities for enhancement. In order to safeguard confidentiality, we kindly request that any identifying details be omitted.

I am attending this program:(Required)

As part of a group from my mikvah and my mikvah is sponsoring my attendance

As an individual participant and covering my own fee

Cost: $36(Required)

Price:

Total

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name