11th Quad-Region Biennial Retreat
Camp Zeke, Lakewood, PA

June 10-12, 2022

* = Required Field

Your Name*

Phone Type*
Phone 2 Type


Address*

Emergency Contact's Name*

Have you been to an FJMC Convention or Regional Retreat previously?

Select your FJMC Region




All participants are required to be
Covid-19 Negative Two Ways:

1.
Bring results of a negative Covid-19 PCR test
taken no more than 72 hours prior to arrival at the camp.

2.
Have a negative rapid Covid-19 test result upon arrival at camp. 


Camp Zeke may require wearing masks, social distancing
and other similar measures as required by
relevant state orders and regulatory guidance.




I have received the full Covid-19 vaccinations and at least one booster.*

I will bring proof of a negative Covid-19 PCR test taken no more than 72 hours prior to arrival at the Retreat.*

I will take a rapid Covid-19 test upon my arrival at camp. I understand that I will only be admitted to Camp Zeke if I have a negative test result.*

Sweatshirt Size

I am a

I am able to


Camp Zeke is a Glatt Kosher facility.


THE CREDIT CARD PAYMENT SECTION WILL APPEAR
AFTER YOU SELECT YOUR REGION ABOVE & AFTER YOU MARK

QUANTITY OF "1" IN THE REGISTRATION BOX THAT WILL APPEAR BELOW.

I'm registering from the Hudson Valley Region
$340 -$100 Regional Rebate = $240
$ 240.00
I'm a First-Timer registering from the Hudson Valley Region
$340 - $200 First-Timer Regional Rebate = $140
$ 140.00
I'm registering from the Middle Atlantic Region
$340 -$200 Regional Rebate = $140
$ 140.00
I'm registering from the New York Metro Region
$340 -$241 Regional Rebate = $99
$ 99.00
I'm registering from the Northern New Jersey Region
$340 -$60 Regional Rebate = $280
$ 280.00
I'm a First-Timer registering from the Northern New Jersey Region
$340 -$160 First-Timer Regional Rebate = $180
$ 180.00

Single Room request
$ 100.00

Refrigerator in Room
$ 25.00

$

Name on Credit Card*

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