Global Connections Israel Travel Registration

PARTICIPANT INFORMATION
Name

First NameLast Name
E-mail*

Confirmation Emailexample@example.com
Birth Date*

MonthDayYear
Date
Mobile Number*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Name as you prefer for your name tag*
Frequent Flyer Number
PASSPORT INFORMATION
Name (as it appears on your passport)*

First NameMiddle NameLast NameSuffix
Passport #*
Issue Date*

MonthDayYear
NOTE: Passports must be valid for at least six months beyond the return date of the mission
Expiration Date*

MonthDayYear
NOTE: Passports must be valid for at least six months beyond the return date of the mission
Please inform us below of any allergies you have.*
Please enter "none" if not applicable
Please inform us below of any prescription medication(s) you take or conditions for which you are presently under physician's care, etc.*
Please enter "none" if not applicable
Please inform us below of any health or medical concerns of which we should be aware.*
Please enter "none" if not applicable

Are you Shabbat Observant?*

YesNo
Please note: Group meals will be Kosher-style.

Kosher-style meals will not include meat but will include vegetarian and fish options. If you require boxed Kosher meals, please indicate below:
Dietary Requirements (check all that apply)

Certified Kosher - please provide boxed kosher mealsVegetarianVeganDiary-free (lactose free)Other (please specify)
If you plan on celebrating a special occasion during this trip, please indicate occasion and date below
Please specify occasion and date
Accommodations are based on double occupancy. If you prefer to have your own room, you may opt in to pay the single supplemental of up to $500.

I would like to pay the single supplement of up to $500 to have a room to myself. I will contact Justine Reuben at jreuben@jfedgmw.org to make payment arrangements.
EMERGENCY CONTACT INFORMATION
Emergency Contact*

First NameLast Name
Relationship
Mobile Number*
Home Number*
Work Number*
SIGNATURE AND AGREEMENTS

IMPORTANT: Must be completed for each participant included in this registration.
Name

First NameLast Name
Date

MonthDayYear
Date
Signature

Clear
Parent / Guardian Name and Signature

For Desert Wolves participants
Parent / Guardian Name

First NameLast Name
Date

MonthDayYear
Date
Parent / Guardian Signature

Clear
Your signature above confirms you have read and understand the release forms and information below.

I have read and full understand the Travel Advisory and Embassy Messages.I have read and full understand the Release of Liability for Death, Personal Injury, and Property Damage.I have read and full understand the the latest update to the Department of State’s Worldwide a.I have read and full understand the Photo / Image Release Statement.I understand travel insurance is required on this trip to provide reimbursement for trip delay, missed connections, sickness and accident medical expenses, lost baggage, personal effects, baggage delay, etc.I agree to participate in all program itinerary programming.
Please check below to confirm.*

I understand that if I cancel my participation after an airline ticket has been issued in my name, I will be responsible for all resulting fees.
Should be Empty:

	Airline and Flight #	Date	Departure Time	Arrival Time
Outbound Flight to Israel
Return Flight to US

PARTICIPANT INFORMATION

PASSPORT INFORMATION

EMERGENCY CONTACT INFORMATION

SIGNATURE AND AGREEMENTS

Parent / Guardian Name and Signature