Civil Rights Mission Registration

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Who We Are
- Our Mission
- How We Help
- Your Impact
- Contact
- Board
- News
- Careers
- Financials
What We Do
Give
Get Involved
Resources
Events
Contact
Donate

Name(Required)

Title First Middle Last

Name as you would like it on name tag(Required)

Birthdate(Required)

MM slash DD slash YYYY

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email(Required)

Home Phone

Cell Phone(Required)

Room Request(Required)

Single: $1,550 (includes supplement charge of $350 per person)

Double: $1,200 (please provide roommate's name)

YAD Single: $1,349 (includes supplement charge of $350 per person)

YAD Double: $999 (please provide roommate's name)

Roommate's Name(Required)

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(Required)

Must be an adult not on Mission.

Emergency Contact Phone(Required)

Add Another Participant

Are you registering another participant?

Yes

Name(Required)

Title First Middle Last

Name as you would like it on name tag(Required)

Birthdate(Required)

MM slash DD slash YYYY

Address Choice(Required)

Same as above

Enter different address

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Home Phone

Cell Phone(Required)

Room Request(Required)

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(Required)

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(Required)

Must be an adult not on Mission.

Emergency Contact Phone(Required)

Agreements

Campaign Participation Agreement(Required)

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(Required)

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

Comments

This field is for validation purposes and should be left unchanged.

Thank you to our Diamond Level Corporate Partner

Thank you to our Gold Level Corporate Partner

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EIN: 25-1017602

2000 Technology Drive
Pittsburgh, PA 15219
412-681-8000
info@jewishpgh.org

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