Registration

AFSI CHIZUK MISSION APRIL 17 – 25, 2018

We are so happy that you have decided to join us on our April 17 – 25, 2018 trip. Kindly fill out this registration form for each individual traveler.

A $500 deposit is due per each registration form to secure your place on the trip.

The balance is due on March 26, 2018.

Total Cost:

$2,500 per person (Double Room)
$3,500 per person (Single Room)

After February 20, 2018 your $500 deposit is NON-REFUNDABLE.

We recommend you secure travel insurance in the event that you cannot travel due to health concerns.

Payments may be made by check, PayPal, or your credit card.

Make checks payable and mail to:
Americans for A Safe Israel
1751 2nd Avenue
New York, NY 10128

We look forward to seeing you on the trip!

Traveler's Legal Name*
Preferred Name
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Israel #
Email*
Passport # ( A copy of your passport is required prior to your final payment)*
- I do not wish to place it here. I will send it in prior to my final payment
I wish to reserve ( Check one)*
- A single room ($3,500)
- A double room ($2,500) Please try to pair me up with a roommate (I understand that I will be charged the single rate if no suitable roommate is found.)
- A double room ($2,500) with ( Please put your roommate's name in the following box)
My roommate's name is

If you reserved a double room and know the name of the roommate you wish to be placed with, kindly type their name below.
I understand that a copy of my passport is required to be on file prior to my final payment)*
- Check
- Other
Other
I understand that a $500 deposit is due with registration to hold my spot, and after submitting this form I'll be directed to PayPal payment page.*
- Yes, I will complete mission trip deposit today.
- Other
Other
Product Name
Total
$0.00