Name
*
First
Last
Phone
*
Email
*
School
*
Grade
*
9
10
11
12
Region
*
Atlanta
Atlantic Seaboard
Argentina
Canada
Central East
Chile
Israel
Midwest
Northeast
New Jersey
New York
Southern
Southwest
West Coast
Parent Name
*
First
Last
Parent Phone
*
Parent Email
*
Dietary Restrictions
*
Please Attach Photo
Accepted file types: jpg, jpeg, png, gif.
Sweatshirt Size
S
M
L
XL
Coupon
Summit Cost
*
Price:
Total
$0.00
Credit Card
*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Date
Security Code
Cardholder Name
What does JSU mean to you?
*
What is your current or future role in JSU?
*
What do you hope to gain from the summit?
*
What would you describe as your biggest challenge as a leader or part of JSU this year?
*
We would love to have you join our planning committee! If so, which of the following would you be most interested in building out? Feel free to choose as many as you would like!
The Shabbat experience (Kiddush, Shabbat meals, Havdalah, opt-in Prayers)
Leadership programming (workshops, education, speakers)
Mentorship programming (a strategy to pair up current and returning members)
Fun activities (games and icebreakers)
Operations (mealtimes, program transitions, decor)
Rooming requests?
*
I understand that after filling out this form I will receive a digital link to waivers and medical information which need to be filled out prior to the event.