312 Walnut Street 
Suite 3600
Cincinnati, Ohio 45202



Please complete the following form to register for this event.

Parents' Names
Parent 1 Name: (Please provide both first and last names)
Parent 2 Name:
Childs' Names
Child 1 Name:
Child 2 Name:
Child 3 Name:
Child 4 Name:
Additional Guests:
Email Address:
How did you hear
about this event?
Is at least one parent (mother or father)
in your household Jewish
Please check here if you are an interfaith or conversionary family (at least one person in your immediate family has converted to Judaism) and would like to be added to our Fusion mailing list: Fusion is an initiative of The Mayerson Foundation for Interfaith and Conversionary couples and families in Greater Cincinnati. For more information please click here: www.Fusionnati.org
If you are new to Shalom Family and we do not have your mailing address, or if your information has recently changed, please complete the fields below
Street Address:
Zip Code:
Phone Number:
Please send me a Microsoft Outlook calendar reminder for this event.
I understand that on occasion, photographs taken of myself and/or my child(ren) may be taken at a Shalom Family event and that these photographs may be used for public relations purposes on our Shalom Family website, in local newspapers or for other purposes to promote Shalom Family programs.