MAKOM

Level Up

Just  as  your  favorite  video  game  offers  the  opportunity  to  complete  levels  
and  move  to  advanced  challenges,  so  does  par&cipa&on  in  Jewish  life.    

     
MAKOM  Registra.on  Form:  Registra)on  requires  a  one  )me  $36  registra)on  fee  (except  Build  A  Tzedakah  Fund)–  addi&onal  fees  are  listed  below  for  individual  programs.    
Choose  more  than  one  program  and  receive  addi=onal  op=ons  at  50%  off  listed  price  (Discount  will  be  applied  to  lesser  priced  program  -­‐  excludes  Philadelphia  Trip  &  AIPAC  Summit)  

Student  Name________________________________________________________________________________      Grade  (2011/12)  __________________________________
Home  Address    ________________________________________________________________________________________________________________________________

Student  Cell:  __________________________________        Text  MSGS:    yes              no                        Home  Phone        __________________________________________________________      
Student  Email  _________________________________________________________________________________________________________________________________
Parent  Name______________________________________________________                      Parent  Name  ___________________________________________________________
Parent  Cell  _____________________________________      Text  MSGS:  yes              no                    Parent  Cell  _______________________________________    Text  MSGS:yes              no
Parent  Email__________________________________________________________      Parent  Email  _____________________________________________________________
As  part  of  our  con=nued  effort  to  market  MAKOM  and  promote  our  students,  occasionally  photos  or  video  footage  will  be  taken  during  
the  program.    These  may  be  used  in  print  marke=ng  or  posted  on  the  internet.

 

I  authorize  the  use  of  my  son/daughter’s  photos    

I  DO  NOT  authorize  the  use  of  my  son/daughter’s  photos

CHECK  THE  APPROPRIATE  BOXES  BELOW    -­‐  VISIT  WWW.MAKOMNH.ORG  FOR  COMPLETE  PROGRAM  INFORMATION
 Wednesday  Night  MAKOM*
Wednesdays  from  7-­‐9  PM  
Begins  September  21st    
Fees:  $100  per  6  week  class;  $200  per  12  week  class;  or  $650  for  
full  year
 Wednesday  Bus  -­‐  Cheshire
Fees:  $375
 Madrichim  Ins.tute  
One  Sunday  a  month  from  10-­‐12  
Begins  on  September  25
Fees:  $0
 Adopt-­‐A-­‐Survivor  
Meets  Wednesday  evenings  during  Wednesday  Night  MAKOM.
Fees:  $400  or  free  as  part  of  registra)on  in  Wednesday  Night  
MAKOM
 Chaver    
Meets  one  Thursday  a  month
Fees:  $150  for  full  year  program  includes  dinner  at  each  session.
 Avodah  
Four  Sunday  Seminars  from  1-­‐3  PM
Begins  on  October  2nd
Fees:  $250

 March  of  the  Living  (April  15-­‐29,  2012)    
Fees:  $4,650  

Payment  Informa.on
Registra.on  Fee  (all  par.cipants)  
 
$36
 
Sibling  Discount  
 
 
$36
 
JCC  Member  Discount    
 
$36
 
Jewish  Communal  Worker  Discount   $36
Program  Fees:  Full  amount  or  50%  due  with  registra=on

 
 
 
 TACT
 
One  mee=ng  a  month  from  7-­‐8  PM  (usually  on  the  second  Tuesday)
 
Begins  on  September  13th    
 
Fees:  $150
 
 AIPAC  High  School  Summit  (November  6-­‐9,  2011)
 Philadelphia  Trip  (February  19-­‐20,  2012).  
Fees:  $250

Wednesday  Classes    
Cheshire  Bus    
 
Adopt  a  Survivor  
 
Chaver    
 
 
Avodah  
 
 
TACT    
 
 
Build  a  Tzedakah  Fund  

 
 
 
 
 
 
 

_________
_________
_________
_________
_________
_________
_________

Fees:  TBA

The  following  programs  require  a  $50  deposit:

 Build  A  Tzedakah  Fund
Fees:  $600

 
 
 

*Please  list  Class  Choices:
___________________________________________________
___________________________________________________

March  of  the  Living    
Philadelphia  Trip    
AIPAC  Summit  
 

 
 
 

__________
__________
__________

Dona.on  to  MAKOM  Scholarship  fund  

___________

___________________________________________________

If  paying  by  Credit  Card:  Amount  ______________________

___________________________________________________

Name  on  card  ______________________________________

               I  wish  to  receive  a  tui.on  assistance  form
 
 

Card  Number  _______________________________________
All  tui=on  assistance  requests  must  be  accompanied  by     Expira&on  Date  _____________________________________
$36  registra=on  fee

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