Deposit for Family Tour #@ID1@

*Title - Make a selection -CantorDr.FatherMr.Mrs.Ms.PastorRabbi

*Traveler First Name

*Traveler Last Name

*Email

*Mobile Phone

Home Phone

*Street

*City

*State/Province - Make a selection -AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYASFMGUMHMPPRPWVIAAAEAPABBCMBNBNLNSNTNUONPEQCSKYTNew South WalesNone

*Zip/Postal Code

*Date of Birth (MM/DD/YYYY)

*Relationship to Purchaser - Make a selection -Primary Traveler (Self)Parent/GuardianSpouseChildFriendOther

Referred By (if applicable)

*Please indicate your preferred T-shirt size - Make a selection -Extra SmallSmallMediumLargeXLXXL

*Profession

*Medical conditions, allergies, and medications/prescriptions (if none, put N/A)

*Passport Number

*Passport date of expiration (A valid passport expires at least six months after the final day of travel.)

*Nationality

I am interested in assistance with flights.

Arrival Date (to Israel)

Arrival Time

Arrival Carrier

Arrival Flight Number

Departing Airport (to Israel)

Departure Date (from Israel)

Departure Time

Departure Carrier

Departure Flight Number

Airport flying to (from Israel)

Desired hotel room accommodations - Make a selection -Single OccupancyDouble Occupancy (twin beds)Double Occupancy (king bed)Package for 2 adults & 1 childPackage for 2 adults & 2 children

Name of Roommate (if applicable)

I am interested in receiving more information and speaking to someone about Travel Insurance.

*I have food allergies:

Please note that most allergy needs can be accommodated with advance notice, though we cannot guarantee the participant will not come in contact with those allergens

- Make a selection -YesNo

Please list any food allergies or dietary restrictions

*I assert that I am able to walk independently without assistance. - Make a selection -YesNo

*I have mobility limitations - Make a selection -No mobilityLimited mobilityI do not have mobility limitations

*I require a walking stick, frame, rollator - Make a selection -YesNo

If yes, please fill below the mobility device you will be using and if you will be bringing your own.

*I require mobility assistance at the airport - Make a selection -YesNo

*Are you able to board/exit a bus and step over a gap independently? - Make a selection -YesNo

Yes, this is the first time traveling to Israel

Yes, this is the first time traveling with JNF

I confirm that I do not have any serious medical condition(s) which would inhibit my full participation unless otherwise specified above. The activities chosen for this trip require stable physical health for extensive touring, walking, etc.