Mission to Cuba

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Registration

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PARTICIPANT INFORMATION
Name for name tag*
E-mail*

Confirmation Emailexample@example.com
Birth Date*

MonthDayYear
Date
Mobile Number*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Name (as it appears on your passport)*

First NameMiddle NameLast NameSuffix
Passport #*
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 health or medical concerns of which we should be aware.*
Please enter "none" if not applicable
Please inform us below of any dietary requirements (gluten-free, vegetarian, Kosher, etc.) of which we should be aware.*
Please enter "none" if not applicable
I would like to register another participant.
PAYMENT AND TRIP COST

Options

$1,800 deposit, per person, due today (fees apply)$2,100, per person, is due in full by Tuesday, October 15, 2024. Indicate the # of registrants and select your preferred method of payment for the remaining balance below. (Note: $500 of the $1,800 deposit, per person, is non-refundable)

$3,900 # of registrants:Payment options:

Optional add-ons

*Single Supplement — $550If you prefer a single room, without a roommate, please select this option.

$550 Payment options:

Pledge your gift to the 2025 UJA Annual CampaignThis mission welcomes individuals and/or households who make a minimum gift of $5,000 to the 2025 UJA Annual Campaign. Your annual gift supports Federation’s lifesaving work around the globe and at home in New Jersey. Pledges to the 2025 UJA Annual Campaign are payable through December 31, 2025.

$1 Amount $Payment options:

Enter coupon

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

PARTICIPANT #2 INFORMATION
Participant #2 Name for name tag*
Participant #2 E-mail*

Confirmation Emailexample@example.com
Participant #2 Birth Date*

MonthDayYear
Date
Participant #2 Mobile Number*
Participant #2 Address

Street Address

Street Address Line 2

CityState

Zip Code
Participant #2 Name (as it appears on your passport)*

First NameMiddle NameLast NameSuffix
Participant #2 Passport #*
Participant #2 Expiration Date*

MonthDayYear
NOTE: Passports must be valid for at least six months beyond the return date of the mission
Participant #2: Please inform us below of any allergies you have.*
Please enter "none" if not applicable
Participant #2: Please inform us below of any health or medical concerns of which we should be aware.*
Please enter "none" if not applicable
Participant #2: Please inform us below of any dietary requirements of which we should be aware.*
Please enter "none" if not applicable
TRAVEL AND ACCOMMODATIONS
Designated Flights:

Newark, NJ to Havana, Cuba departing on Wednesday, December 4, 2024
American Airlines #AA323738 — Newark (EWR) • 4 DEC 8:07 AM ✈ 11:20 AM 4 DEC • Miami (MIA)
American Airlines #AA837319 — Miami (MIA) • 4 DEC 1:40 PM ✈ 3:00 PM 4 DEC • Havana (HAV)

Havana, Cuba to Newark, NJ departing on Sunday, December 8, 2024
American Airlines #AA838319 Havana (HAV) • 8 DEC 4:00 PM ✈ 5:14 PM. 8 DEC • Miami (MIA)
American Airlines #AA2008319 Miami (MI) • 8 DEC 9:00 PM ✈ 12:08 AM 9 DEC • Newark (EWR)
Participants are responsible for coordinating and booking their own flights. Please select one of the following options:

I/we have booked the designated flights listed above.I/we have booked alternate flights.I/we have not yet booked my flights. I/we will email Jill Pascol, at jpascol@jfedgmw.org with my flight information.

Roommate (select one)*

I wish to room with someone specificPlease assign me a roommate

Note: When possible, Federation will attempt to find roommates if requested. However if we are unsuccessful, participant will be subject to the single supplement charge.
I prefer not to have a roommate and agree to pay the single occupancy supplement of $550.
Please indicate the name of your preferred roommate

First NameLast Name
Bed Type (select one)*

One bedSeparate beds
If you plan on celebrating a special occasion during this trip, please indicate occasion and date below
Please specify occasion and date
EMERGENCY CONTACT INFORMATION
Emergency Contact*

First NameLast Name
Relationship
Mobile Number*
SIGNATURE AND AGREEMENTS

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

First NameLast Name
Date

MonthDayYear
Date
Signature

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

I have read and fully understand the Photo / Image Release Statement.I understand travel insurance is required on this mission.I understand $500 of my deposit is non-refundable.
The fields below must be completed by {participant2}
Participant #2 Name

First NameLast Name
Date

MonthDayYear
Date
Participant #2 Signature

Clear
Participant #2, your signature above confirms you have read and understand the release forms and information below.*

I have read and fully understand the Photo / Image Release Statement.I understand travel insurance is required on this mission.I understand $500 of my deposit is non-refundable.

	Airline and Flight #	Date	Departure Time	Arrival Time
Outbound Flight
Return Flight

Online registration is now closed

Registration

PARTICIPANT INFORMATION

PAYMENT AND TRIP COST

PARTICIPANT #2 INFORMATION

TRAVEL AND ACCOMMODATIONS

EMERGENCY CONTACT INFORMATION

SIGNATURE AND AGREEMENTS