2019 JCC Maccabi Games® Athlete Registration

Participant Information

First Name :
Last Name :
Date of Birth :
Grade :
Gender :
 Male
 Female
Sport :
Cell Phone :
Email Address :
Social Media Handles :

Parent/Guardian Information

Parent/Guardian 1 Name :
Parent/Guardian 1's Cell Phone :
Parent/Guardian 1's Email :
Parent/Guardian 2 Name :
Parent/Guardian 2's Cell Phone :
Parent/Guardian 2's Email :

Payment Information

The deposit is non-refundable and will secure your spot on the team.

The application for financial assistance can be found at https://atlmaccabi2019.org/financial-assistance/.

Are you currently a member of the MJCCA?
 Yes
 No

This form authorizes the MJCCA to charge your card the specified amount below.

Payment Amount :
 MJCCA Member Pay in Full: $750
 MJCCA Non-Member Pay in Full: $850
 Pay $500 Deposit (The balance will be charged on 5/1/19)
 Pay $50 Financial Assistance Deposit
Card*
Name on card*
Credit Card Number*
Expiration*
Billing Address :
Billing City :
Billing State :
Billing Zip Code :


Please note: this is only for financial registration and not for the national registration. Please complete your national registration at https://atlmaccabi2019.org/jcc-association-national-registration/.

clientuploads/200-width/logo-AffiliateJFGA.jpg