Jewish Educators Assembly - 66TH Annual Conference - Beer sheva/jerusalem Monday, February 12 - Sunday, February 18, 2018 Instructions - Please read carefully: This form is for people who have previously registered and are making additional payments towards their balance. Cancellation Policy: Refunds are subject to airline and hotel policies. In all cases, JEA will retain a $100 administrative fee for any cancellations received after December 1, 2017. Prefix * - Select -Mrs.Mr.Ms.Dr.RabbiCantor First Name: * Last Name: * Email: * Enter the payment amount that you are making now: * $ Do not include commas or periods. Enter number in whole dollar amounts such as '1450'. BALANCE DUE BY JANUARY 10, 2018 Billing Information This information should match the Credit or Debit Card being used for this transaction. First Name * Last Name * Address * Address Line 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Credit Card Information Enter your credit card details below. Payment Information First name * Last name * E-mail * Card type Visa Mastercard American Express Card number * Security code 01- January02- February03- March04- April05- May06- June07- July08- August09- September10- October11- November12- December 2019202020212022202320242025202620272028 By clicking the "Register" button below you are agreeing to our Terms and Conditions. Please review all fields above as there is no "review" step and your card will be charged immediately. Do not click more than once or you may be double charged! CANCELLATION POLICY: Refunds are subject to airline and hotel policies. In all cases, JEA will retain a $100 administrative fee for any cancellations received after December 1, 2017. 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: [email protected] Web-site: www.Jewisheducators.org