______EC R E G I S T R A T I O N F O R M_-______
Jewish Educators Assembly – 65th Annual Conference – Los Angeles, CA
Sunday, November 13 - Wednesday, November 16, 2016
Warner Center Marriott, Woodland Hills, CA
q Mrs. q Mr. q Cantor
Name: ______q Ms. q Rabbi. q Dr.
Last First MI
Home Address: ______
Number & Street City State Zip
Home Phone: (____)______Home Fax: (____) ______Home E-Mail: ______
Organization/Synagogue/School ______
Position/Title: ______
Work Address: ______
Number & Street City State Zip
Work Phone: (____)______Work Fax: (____) ______Work E-Mail: ______
Cell Phone: (____)______Is this your first JEA Conference? ___Yes ___No
I work in the following educational setting(s): (check all that apply)
____ Family Education ____ Early Childhood ____ Summer Camp
____ Day School ____ Bureau or Agency ____ Informal Education
____ Congregational School ____ Academic ____ Other ______
Number of students in your school: _____ Early Childhood _____ K – 7 _____ 8 – 12
Number of years in your current position: ______
Conference Registration Fee:
Early Childhood Educators ___JEA Member* $150 ___Non-member $300
*To receive member rate, all dues must be current including the 2016-2017 year.
(Local educators who are not staying at the hotel do not pay this Conference Registration Fee above. For Yom I’yun fees, see page 2)
Conference Registration Fee: $ ______
Hotel, Meals, and Program (Nov. 13-16):
(Includes room and meals beginning with dinner on night of arrival and ending with lunch on departure date)
Date of Arrival ___/___/___ Date of Departure ___/___/___
1 DAY 2 DAYS 3 DAYS
Single Occupancy ___ $595 ___ $1,050 ___$1,425
Double Occupancy ___ $535 ___ $900 ___$1,225
Spouse/Partner/Companion (Name:______) ___ $535 ___ $900 ___$1,225
Optional Add-On Days: ROOM ONLY – NO MEALS
___Fri. Night, November 11 ___Sat. Night, November 12 ___Wed. Night, November 16 --- Thu. Night, November 17
__ $185 - Single Occupancy __ $185 - Single Occupancy __ $185 - Single Occupancy __ $185 - Single Occupancy
__ $ 93 - Double Occupancy __ $ 93 - Double Occupancy __ $ 93 - Double Occupancy __ $ 93 - Double Occupancy
Total Hotel Fees: $ ______
Individual Preferences/Requests:
All rooms are non-smoking
Roommates: ___ Please assign a roommate for me. (You will be obligated to pay the single occupancy rate for any night that a roommate cannot be found for you.)
___ I will be sharing a room with: (Name)______
(Please check with potential roommate prior to listing on this form.)
Dietary: ___ Vegetarian ___Other ______
(continued on reverse…)
EARLY CHILDHOOD Y’MEI IYUN FEES: (Early Childhood Educators who are attending the
EC Y’mei Iyun pay the fees below ONLY. They do not pay the Conference Registration Fee above.
___ Monday, November 14 - $150: Featured Speakers, EC Workshops, Lunch and Snacks: 9:00am – 4:00pm
___ Tuesday, November 15 - $150: Site visits to local EC Centers, Workshps, Lunch and Snacks: 9:00am – 4:00pm
Total Y’MEI Iyun Fees: $ ______
A Deposit equal to one day’s hotel fee, plus the conference TOTAL AMOUNT DUE: $ ______
registration fee, must accompany your completed registration (Please add all amounts)
form to secure your registration. Commuters please submit full
payment with application.
Balance is due by October 26, 2016. AMOUNT ENCLOSED: $ ______
BALANCE DUE: $ ______
Method of Payment
Payment may be made by check or credit card. All checks, payable to the Jewish Educators Assembly, must be in U.S. dollars and drawn against a bank in the U.S. For payment by credit card, complete the following (Please print clearly):
___ MasterCard ____ Visa ____ American Express
Acct #: ______- ______-______- ______
Expiration Date: ______/______ Three or four digit security code from back of card: ______
Your name AS IT APPEARS ON THE CREDIT CARD: ______
Credit Card Billing Address: ______
Number Street City State Zip
(**CREDIT CARD NUMBERS AND BILLING ADDRESS INFORMATION MUST BE CORRECT AND COMPLETE IN ORDER TO PROCESS YOUR REGISTRATION. PLEASE CHECK ALL NUMBERS CAREFULLY AND WRITE CLEARLY.)
Return this form along with your check or credit card information to:
Jewish Educators Assembly Broadway and Locust Avenue, P.O. Box 413, Cedarhurst, NY 11516
CANCELLATION POLICY: Cancellation must be received at the JEA office by October 26, 2016. 50% of the Registration Fee/Commuter Registration Fee paid will be returned; the other 50% is non-refundable. If your arrival is later or departure earlier than the date indicated on the registration form, you must notify the JEA and the hotel 72 hours in advance of the change, otherwise you will forfeit one day’s charge for food and lodging. ROOM ASSIGNMENT: If a double occupancy room is not filled, the JEA reserves the right to reassign the remaining occupant to another double room. You are obligated to inform the desk and JEA by 5:00pm on your day of arrival if you have no roommate. Otherwise you will be charged the full single room rate.
REGISTRANT’S SIGNATURE: ______
NOTE ABOUT T’FILOT: For services at the conference, please let us know how you would like to be involved:
I would like a role in: q Shacharit q Mincha q Ma’ariv q Hamotzi q Birkat Hamazon q Kriat HaTorah
For more information, contact: JEA CONFERENCE
Broadway and Locust Avenue, P.O. Box 413, Cedarhurst, NY 11516
Phone: (516) 569-2537 Fax: (516) 295-9039
E-mail:
Web-site: www.Jewisheducators.org