Israel Trip

Full Name*

First NameLast Name

Hebrew Name*

First name as you would like it on the name badge*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home phone

Area CodePhone Number

Mobile

Area CodePhone Number

E-mail*

*We need this information since we will be, G-d willing, purchasing the airline tickets and this information is required

*For travel to many overseas destinations, your passport must be valid for at least 6 months past the date of your return. If you do not have your passport available at this time please enter "NA".

Will you be joining our group for the Miami-TLV flight on Aug 8th?*

YesNo

Will you be returning together with our group for the return flight TLV-Miami on Aug 16th?*

YesNo

Name as it appears on Passport*

Passport number*

Passport expiration date*

Country of issue*

Country of citizenship*

Birth Date*

MonthDayYear

Gender*

MaleFemale

Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

E-mail*

Relationship to participant*

Please list all medical conditions. Also, please tell us if you use a cane, walker, etc*

Please list all allergies*

Please list all prescriptions

All meals are Kosher Mehadrin. All breakfasts, three Shabbat meals, and three dinners are included. Weekday lunches and the other dinners are a perfect time to meet up with friends/relatives and check out the eateries of your choice.

Do you have any special dietary needs/meal requests?

Will you be joining us for Shabbat?

YesNo

Will you be joining us for all meals?

YesNo

Besides the Kotel, which sites are most important for you to visit? i.e. Holy sites, Yad Veshem, Museums, Dead Sea, Chevron, Biblical history sites, etc.

What is your main purpose of this trip?

How long can you handle touring per day (including travel time)? 3 hours? 5 hours? 10 hours?

How long can you walk without needing to sit down? Is a 3 hour tour too long? Please clarify

Occupancy

Single OccupancyDouble Occupancy

If double, who will be your companion?

Will you be staying in our hotel for the entire trip or going to friends/relatives/othrs for any part of the trip?

Any special requests or suggestions?

1. Your Information

2. Passport Information

3. Emergency Contact Information

4. Medical Information

5. Meal Information

6. Touring Information

7. Accommodation Information

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