Robert E. Loup Jewish Community Center
JCC Maccabi 2011 Athlete/Artist Registration Join Team Denver for an unbelievable JCC Maccabi Experience! Denver will send a delegation to each of this summers hosts: Israel, Philadelphia and Springfield. Teens may choose to compete in Israel or in the US. Please note the specific sports teams traveling to the US cities has not yet been determined. Athletes must turn 13 by July 31, 2011. NAME: ______________________________________________________________________________________ DATE OF BIRTH (DOB): _____________________ ADDRESS: ____________________________________________________________________________________________________________________________ CITY: _____________________________________________________________________________ STATE: ___________________ ZIP: ____________________ ATHLETE/ARTIST EMAIL: ________________________________________________________________________________________________________________ HOME PHONE: _____________________________________________ ATHLETE/ARTIST CELL PHONE: ________________________________________________ SCHOOL: ________________________________________________________ SYNAGOGUE: ________________________________________________________
PARENT’S NAME: ______________________________________________________________________________________________________________________ HOME PHONE: _________________________________________________ CELL PHONE: ___________________________________________________________ PARENT’S EMAIL: _____________________________________________________________________________________________________________________
How did you hear about the Game? ____________________________________________________________________________________________________ Please rank the top three sports in the location that you would like to compete in from the list below by numbering 1—3. One sport must be an individual sport.
Israel Games & Artsfest
Philadelphia/Springfield*
July 24—August 5, 2011 Ages 14—17 (as of July 31 2011) Fee: $3,500
August 14—19 Ages 14—16 (as of July 31, 2011) Fee: $,1600
TEAM SPORTS: ❑ Basketball ❑ Soccer ❑ Bowling ❑ Tennis ❑ Swimming ❑ Table Tennis ❑ Volleyball
ART SPECIALTIES: ❑ Acting/Improv ❑ Culinary Arts ❑ Dance ❑ Broadcast Journalism ❑ Visual Arts ❑ Jazz/Rock/Vocal Music
SPORTS: ❑ Girls Soccer ❑ Boys Baseball ❑ Girls Volleyball ❑ Boys & Girls Basketball ❑ Golf ❑ In-line Hockey ❑ Track and Field ❑ Lacrosse ❑ Table Tennis ❑ Soccer ❑ Bowling *Games locations will be determined based on results from team tryouts and ❑ Dance national allowment. ❑ Swimming ❑ Tennis
For more information please contact our Team Denver delegation heads Jamie Skog at (303) 316-6391 or jskog@jccdenver.org Yuri Tavbin at 303-316-6304 or ytavbin@jccdenver.org 350 South Dahlia Street • Denver, CO 80246 • (303) 316-6349 • www.jccdenver.org
Payment Information Games Participation Fee: $3,500/athlete/artist Philadelphia and Springfield $1,600/athlete Discount Opportunities Full Payment Discount- $50 off the fee per athlete/artist Payment must be made in full by February 14, 2011 to receive this discount Sibling Discount- $100 off the fee per athlete/artist Any participant who has a sibling also registered to participate may receive this discount. $100 will be deducted from the total participation fee for each athlete/artist. A family with two children enrolled in a Maccabi Experience will receive $200 off of their family’s total fees. Scholarships are available to those who need additional assistance. Please contact our office at (303) 316-6391 for a scholarship application form.
Please fill in amount for all discount credit here. $1600 Games participation fee -$50 Full Payment Discount ($50)
Sample Discount Worksheet
-$100 Sibling Discount ($100) $1450 TOTAL
Please fill in amount for all discount credit here. _____ Games participation fee ($3,500 or $1,600) _____ Full Payment Discount ($50) _____ Sibling Discount ($100/child) _____ TOTAL Enclosed is my payment of $_________
Payments may be made in installments based on the plan below Deposit: Domestic $250 (due January 1, 2011) Israel $500 (due December 15, 2011) First Payment: Domestic $500 (due February 14, 2011) Israel $1500 (due February 14, 2011) Second Payment: Domestic $500 (due March 14, 2011) Israel $1500 (due March 14, 2011) Third Payment: Domestic $350 (due April 14, 2011)
Type of Payment ❒ Please find enclosed check number ________________________________________ (payable to “JCC”) for $ ____________________________ ❒ Please charge $ _______________________________________________________ to my credit card account. Name of cardholder ______________________________________________________ ❒ Visa ❒ Mastercard ❒ Discover Card number _________________________________________________________ Expiration Date Month _____________ Year _____________ I hereby authorize the JCC to charge my credit card. ❒ Full amount ❒ According to payment plan above Signature _____________________________________________________________________________________________________________ Please sign this form and return to: JCC Maccabi Games®, 350 S. Dahlia St., Denver, CO 80246