FALL 2024 MEAL PLAN REGISTRATION FORM
STUDENT INFORMATION
Last Name
First Name
Birthday
Email
Mobile Phone
HOME INFORMATION
Home Street
Home City
Home State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Other
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
Please select...
Delta Phi Epsilon
Alpha Epsilon Pi
Sigma Phi Epsilon
Sigma Alpha Mu
Delta Delta Delta
Alpha Delta Pi
Sigma Alpha Iota
Zeta Beta Tau
Beta Theta Pi
Delta Chi
Kappa Alpha
Delta Gamma
Kappa Sigma
Zeta Psi
Sigma Delta Tau
Alpha Phi
Alpha Tau Omega
Sigma Nu
Kappa Alpha Theta
Delta Epsilon Mu
Alpha Chi Omega
Phi Delta Theta
Sigma Chi
Phi Kappa Tau
Alpha Phi Omega
Alpha Xi Delta
Zeta Tau Alpha
Delta Tau Delta
Kappa Delta
Alpha Sigma Phi
Delta Sigma Phi
Phi Sigma Kappa
Tau Kappa Epsilon
Sigma Kappa
Phi Sigma Sigma
Tau Epsilon Phi
Lambda Chi Alpha
Alpha Epsilon Phi
Alpha Kappa Psi
Phi Alpha Delta- Pre-Law Professional Fraternity
Alpha Omega Epsilon
Phi Gamma Delta (FIJI)
Omega Nu Eta
Theta Chi
Phi Kappa Psi
Phi Chi Theta
Alpha Omicron Pi
Chi Phi
Sammy
Sigma Alpha
Omega Psi Phi
Sigma Alpha Epsilon
Gamma Phi Beta
Theos
Alpha Delta Phi
Sigma Gamma Rho
Sigma Beta Rho
Alpha Eplison Pi
Lamda Chi
Delta Upsilon
Kappa Lambda Xi
Phi Gamma Delta
Phi Sigma Pi
Alpha Sig
Alpha Chi Sigma
Alpha Theta Gamma
Zeta Phi Beta
Alpha Gamma Rho
Campus Address
Graduation Year
Please select...
2030
2029
2028
2027
2026
2025- December
2025
2024- December
2024
2023- December
2023
2022- December
2022
2021- December
2021
2020 - December
2020
2019 - December
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
Type of Affiliation
Please select...
Student - Undergrad
Student - Graduate
Parent
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?
YES
NO
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?
YES
NO
MEAL PLAN SELECTION
Please indicate the quantity of each meal plan you wish to purchase below.
Platinum Plan (all meals + 5 Guest Meals) - $3,225
Please select...
0
1
Gold Plan (75 Meals + 3 Guest Meals) - $1,100
Please select...
0
1
2
Silver Plan (55 Meals + 2 Guest Meals) - $845
Please select...
0
1
2
Bronze Plan (40 Meals) - $650
Please select...
0
1
2
Breakfast Plan - $350
Please select...
0
1
2
Passover Plan - $175
Please select...
0
1
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 With Your UID 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
MM
YY
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