Camp Magazines 2017 Camp Magazine | Page 26

Last Name

Address

First Name

City / State / Zip Phone ( Home ) ( Work ) ( Cell )

Membership #

Scholarships

��I am interested in scholarship information

Deadline for scholarship applications is April 17 , 2017 Scholarship does not apply to Specialty Camps .

Payment Options

Electronic Funds Transfer ( EFT ) Pre-authorized debit on the 15th of each month from your checking account . Your first monthly payment and voided check will be required to set up this option .

Authorization Agreement for Pre-Arranged Payments ( Debits ) I ( We ) authorize the Weinstein JCC to initiate debit entries to my ( our ) checking account maintained at the bank named below , herein after called Bank .

This authority is to remain in full force and effect until Bank has received written notification from me ( or either of us ) to its termination in such time and in such manner as to afford Bank a reasonable time to act on it . A customer also has the right to question Bank about any debit entry by notifying Bank no later than 60 days after Bank sends a statement to customer containing the entry . Bank will handle all such questions in accordance with its procedures and the requirements for resolving errors found in Regulation E issued by the Federal Reserve Board .

# of Months _________ Start Month ( must begin by June )

S . S .#

Bank Name

Signature

Please staple voided check to the top of this page

��I am not a member

������������5:00�������PM )

For Camp Hilbert and Specialty Camps only ; does not apply to 12-month families .

Select all weeks that after-care will be utilized at $ 10 per week . If not registered , charge will be $ 10 per day .

���Week 1 ���Week 4 ���Week 7 ���Week 10 ���Week 2 ���Week 5 ���Week 8 ���Week 11 ���Week 3 ���Week 6 ���Week 9

Credit Card

Please complete the appropriate form with credit card number , expiration date , preferred process date and signature . ( Pre-authorization from your VISA , American Express or MasterCard monthly .)

��Visa ��Mastercard ��American Express

Preferred Process Date ( 15th , 22nd , or 30th )

# of Months _________ Start Date ( must begin by June )

First Name

Last Name

Credit Card #

Exp . Date ______________________ Security Code

Signature ���I wish to contribute to the Scholarship Fund

Contribution Amount for Scholarship $

Total Balance Due by June 2 , 2017 Total Fees Less Deposit

$

For Office Use Only : Member # ______________________ Batch # ______________ Date Received ______________ Date Entered ______________

26