Name of Student:
Student's Declaration

Please reserve a space for me at MMY. I agree to be in attendance for the entire and complete academic year (beginning September 2, 2019), to attend all classes and activities, fulfill all academic requirements and adhere to all policies, rules and regulations.

Student's Signature (Please enter the student's name as a signature.)
Date signed: (Please enter the date the student signed the agreement.)
Parent's Declaration

I recognize that by registering my daughter for MMY, I am committing to abide by the schedule of payments listed on the financial information page. (If I choose to register my daughter for the Yeshiva University Joint Israel Program, I will send a copy of the confirmation letter by May 6, and confirmation of payments when available.) I also realize that the NIS 10,000 registration fee is not refundable under any circumstances, and I agree to the financial refund policy. I am enclosing the NIS 10,000 registration fee, and I will arrange for the balance of tuition (via FACTS for the July 15 and October 28 payments or Yeshiva University documents) by May 6, 2019.

Parent's Signature (Please enter the parent's name as a signature.)
Date signed: (Please enter the date the parent signed the agreement.)

As explained on the financial information page, the non-refundable registration deposit is 10,000 Israeli Shekels. If you choose to pay by credit card, your card will be charged in US Dollars. The conversion is based on the official exchange rate in effect on the date of payment.

Based on today's exchange rate, the registration fee converts to US$ 2715.18 . This is the amount that your credit card will be charged if you register now.

Credit Card Information
Card Holder Name:
Card Type:
Card Number:
Card Validation Number:
Expiration Date: /