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Wire Securities or Cash
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State College
Get Involved
Young Families
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Civil Rights Mission
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Miss
Mr.
Mrs.
Ms.
Mx.
Prof.
Rev.
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Middle
Last
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Address Line 2
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Email
Home Phone
Cell Phone
Room Request
Single (supplement charge of $350 per person)
Double (please provide roommate's name)
YAD Single (supplement charge of $350 per person)
YAD Double (please provide roommate's name)
Roommate's Name
Dietary Requests
Kosher
Vegetarian
Gluten Free
Other
Other Dietary Request
Medical Information
Please list all allergies, prescriptions, medical conditions, and special accommodations needed.
Emergency Contact Name
Must be an adult not on Mission.
Emergency Contact Phone
Add Another Participant
Are you registering another participant?
Yes
Name
Dr.
Miss
Mr.
Mrs.
Ms.
Mx.
Prof.
Rev.
Title
First
Middle
Last
Name as you would like it on name tag
Birthdate
MM slash DD slash YYYY
Address Choice
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Enter different address
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Street Address
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City
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Afghanistan
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Bolivia
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Bosnia and Herzegovina
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Bouvet Island
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Chile
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Email
Home Phone
Cell Phone
Room Request
Single (supplement charge of $350 per person)
Double (please provide roommate's name)
YAD Single (supplement charge of $350 per person)
YAD Double (please provide roommate's name)
Roommate's Name
Dietary Requests
Kosher
Vegetarian
Gluten Free
Other
Other Dietary Request
Medical Information
Please list all allergies, prescriptions, medical conditions, and special accommodations needed.
Emergency Contact Name
Must be an adult not on Mission.
Emergency Contact Phone
Agreements
Campaign Participation Agreement
I understand that participation in this Mission requires a minimum commitment of $1,800 each year to the 2024 and 2025 Federation Community Campaigns (or $500 for young adults ages 22-45 at the time of the Mission).
Yes, I (we) agree.
Photo Release and Liability Agreement
By registering for this event, you agree that your (and your guest's) picture and/or video may be taken and potentially used in Jewish Federation marketing material and social media.
Yes, I (we) agree.
Payment Information
When you submit your registration, you will be redirected to a payment form. You may simply pay your $300 per person deposit at this time, or any additional amount.
Your Total
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