Shorashim Ambassador Registration

Registration Information

First Name:

Last Name:

Email Address:

Cell Phone Number (xxx-xxx-xxxx):

Birthdate (MM/DD/YYYY):

College Status:


Graduation Year:

Greek Affiliation:

Youth Group Affiliation:

Day School Affiliation:

Camp Affiliation:

Have you served as a JNF Fellow?


Use only letters and numbers. Must be between 4 and 20 characters long.

Confirm Password:

I agree that by registering through the button below, I will abide by the rules of the Shorashim Ambassador program and that my participation is subject to the discretion of Shorashim.