Registration Bay Area

*Required
First Name *
Last Name *
Grade In The Fall of 2019 *
89101112other
Phone *
Email *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Date of Birth *
Which School Do You Attend *
What is the best way to communicate with you? *
TextWhatsAppEmailPhone
Do You Keep Shabbat? *
YesNoMaybe
Do you have any physical limitations? *
Any Special Talents You'd like to share with the group? *
Why do you want to join Club Z? *
(250-word limit)
Why is Israel important to you? *
(250-word limit)
What makes you a strong leader? *
(250-word limit)
Do you agree to schedule an interview and/or attend one of our recruitment events? *
Yes
Your Commitment: To Be Admitted to Club Z Institute means you are making a commitment to attend all required events and meetings, retreats and national conference *
Yes

Parent 1 First Name *
Parent 1 Last Name *
Parent 1 Phone Number *
Parent 1 Email Address *
Parent 2 First Name
Parent 2 Last Name
Parent 2 Phone Number
Parent 2 Email Address
Dates
Pricing Breakdown for Mandatory Club Z Activities:
Sept 6-8th Retreat Price:$300
Institute Dates: $275
1) 09/22/2019
2) 10/06/2019
3) 10/20/2019
4) 11/03/2019
5) 11/17/2019
6) 12/08/2019
7)12/15/2019
8) 01/12/2020
9) 02/02/2020
10) 02/09/2020
11) 03/01/2020
12) 03/15/2020
13) 04/05/2020
14) 04/26/2020
15) 05/17/2020
January 17th-20th National Conference: Payment will be submitted at a later date.
Instructions
After submitting your application below, you will be directed to a page with payment information.

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