Mezuza Drive

Get a Mezuzah for your dorm or apartment and hang it with pride!

Full Name*

First Name Last Name

Home (Non-NSU) Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*

Area Code Phone Number

E-mail*

Birth Date*

Month Day Year

Hebrew Name*

Hebrew Name Mother's Hebrew Name

Which of your parents are Jewish?*

Both Mom Dad None

Are there any conversions in your family?*

Yes No

School Attending:*

I am a:*

Undergrad Grad

Program:*

Program Graduation Year

I agree:*

This Mezuzah is a gift through Chabad at NSU and Mezuza Club. I hereby commit to looking after this Mezuzah. When I move out of my apartment I will either take it with to affix on my new door or I will have it returned to Chabad at NSU for another student to use.

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This program is generously sponsored by the Mezuzah Club!

Sign up for your Mezuzah!

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