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Register for Massa: A Teen Journey Toward Israel and Self Discovery

Samis Foundation has covered the $360 tuition for students enrolled in the MASSA class. Participants must be either CBI or TBO congregants and their families must be in good standing with their assigned synagogue.

If your student is only interested in the MASSA Israel Program's monthly classes and not the Israel trip, they must still register.

The total cost for the ISRAEL trip is $4,000 per student. Scholarships and fundraising opportunities are available. A link to the scholarship application form will be sent with your registration confirmation. Funds will be allotted based on financial need and student participation in fundraising.

* Student's Name:

* Student's Date of Birth:

* School grade as of September 2022:

8th
9th
10th
11th

Student's telephone (optional):

Student's Email (optional):

Select one or more options for student's preferred pronouns:

They, Them, Their
He, Him, His
She, Her, Hers
Other (specify below)

Other preferred pronouns:

* Please list any emergency medical conditions or information (allergies, medications, etc.)

* Parent's Name:

* Parent's telephone:

* Parent's Email:

* Member of:

	Congregation Beth Israel
	Temple Beth Or

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

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