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Home
Men's Club Health Forum 11/16/25
Please verify reCaptcha before submitting the form.
*
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Are you a member of MJC?
Yes
No
Are you a member of another synagogue?
Yes
No
What synagogue do you belong to?
*
Are you a member of Men's Club?
Yes
No
Would you like information about future events?
Yes
No
*
Number of adults attending
0
1
2
3
4
5
6
7
8
9
10
*
Names of Adults Attending
Please indicate if you have any dietary requirements
Vegan
Vegetarian
Gluten Free
Dairy Free
Other (please indicate below)
Men's Club Dues
If you would like to pay your Men's Club dues at this time, they are free for first two years of joining MJC and $40 a year going forward.
Payment can be made by:
Check payable to Men's Club MJC sent to Merrick Jewish Centre, 225 Fox Blvd, Merrick, NY 11566
Venmo to @Merrickjc-MensClub
* I understand that photos and/or videos may be taken by MJC at this event that may be used for promotional purposes in emails, on social media, and in print. I hereby grant permission for such use, and I hereby release the Merrick Jewish Centre, and its officers and directors, from any claims and liability that may arise from use of said photographs and/or videos. If I decide to not allow photos or videos of me or my child(ren) to be used I understand that I need to contact MJC at comms@mjc.org within 24 hours of the event ending.
* I understand that photos and/or videos may be taken by MJC at this event that may be used for promotional purposes in emails, on social media, and in print. I hereby grant permission for such use, and I hereby release the Merrick Jewish Centre, and its officers and directors, from any claims and liability that may arise from use of said photographs and/or videos. If I decide to not allow photos or videos of me or my child(ren) to be used I understand that I need to contact MJC at comms@mjc.org within 24 hours of the event ending.
*
By checking here, I agree to abide by all security measures put in place by MJC for the day of this program.
By checking here, I agree to abide by all security measures put in place by MJC for the day of this program.
Wed, November 5 2025 14 Cheshvan 5786
