Registration Form
Staff
Directory
Member Priority Registration through August 22nd.
PLEASE PRINT CLEARLY
If participant is under the age of 18, please fill in parent information
and then list the participant in the space provided. All forms must
be completed in full in order to be processed. Date of birth will
default to 1901 if not provided.
ACCOUNTING
Craig Brotzman
CHIEF FINANCIAL OFFICER
Parent/Guardian Last Name
cbrotzman@weinsteinjcc.org • 545-8614
Andrew Gottlieb
Home Address
ACCOUNTS PAYABLE
First Name
Date of Birth
City
State
Work/Cell Phone
E-mail
City
State
ZIP Code
agottlieb@weinsteinjcc.org • 545-8612
Home Phone
Joey Wood
IT/DATA PROCESSING
m Check here if billing and home address are the same. If different fill out below.
jwood@weinsteinjcc.org • 545-8645
Linda Sharp
ACCOUNTS RECEIVABLE
Billing Address
lsharp@weinsteinjcc.org • 545-8613
ZIP Code
Do you or your child receive support s