SPRING 2024 MEAL PLAN REGISTRATION FORM

STUDENT INFORMATION

Last Name

First Name

Birthday

Mobile Phone

HOME INFORMATION

Home Street

Home City

Home State

Home Zip

Home Synagogue

High School

CAMPUS INFORMATION

UMD Student ID

UID Barcode Number

If you dont have your UID yet just enter seven 1's and email ldonaldson@marylandhillel.org when you receive it.

Greek Affiliation

Campus Address

Graduation Year

Type of Affiliation

PARENT ONE INFORMATION

PLEASE USE A UNIQUE PHONE NUMBER AND EMAIL FOR PARENT 1 (DIFFERENT FROM STUDENT AND PARENT 2) OR YOUR FORM WON'T PROCESS!

Last Name (P1)

First Name (P1)

Email (P1)

Mobile (P1)

Type

Is Parent One's Home Address The Same As The Student's?

YESNO

PARENT TWO INFORMATION

PLEASE USE A UNIQUE PHONE NUMBER AND EMAIL FOR PARENT 2 (DIFFERENT FROM PARENT 1 AND STUDENT) OR YOUR FORM WON'T PROCESS!

Last Name (P2)

First Name (P2)

Email (P2)

Mobile (P2)

Type

Is Parent Two's Home Address the Same as The Student's?

YESNO

MEAL PLAN SELECTION

Please indicate the quantity of each meal plan you wish to purchase below.

Platinum Plan (all meals + 5 Guest Meals) - $3,145

Gold Plan (75 Meals + 3 Guest Meals) - $1,075

Silver Plan (55 Meals + 2 Guest Meals) - $825

Bronze Plan (40 Meals) - $625

Breakfast Plan - $340

PLEASE INDICATE YOUR PAYMENT PREFERENCE

Payment Options (please note 3% fee for credit card and 6% fee for Installment Plan)

Online Credit Card (Processed By Authorize.net)Send Physical Check to Maryland Hillel (7612 Mowatt Lane, College Park, MD 20740)Monthly Installment Plan for Platinum Meal Plans Only (Please contact Liz Donaldson at ldonaldson@marylandhillel.org for installment paperwork.)

TOTAL COST OF MEAL PLANS

Total to be Charged $

CREDIT CARD DETAILS (new)

Name on Card

Card Number

Code

Billing Email

BILLING ADDRESS

First Name

Last Name

Address Line 1

Address Line 2

City

State/Province

Postal Code

Authnet_Hidden_Fields

OPPORTUNITY_TYPE

PRIMARY_CAMPAIGN_SOURCE

OPPORTUNITY_NAME

Contact Information