THE J² REGISTRATION FORM.
PLEASE COMPLETE THIS FORM FOR EACH TRAVELER.
A J
2
REPRESENTATIVE WILL BE IN TOUCH TO SHARE MORE INFORMATION AND COLLECT MORE DETAILS CLOSER TO THE TRAVEL DATE.
TRIP NAME
Park Avenue Synagogue | Bnei Mitzvah Trip To Israel | Led by Rabbi Neil Zuckerman
CONTACT DETAILS
SURNAME
FIRST NAME
MIDDLE
PRONOUNS
(Optional) What are your pronouns? (e.g. she/her, he/him, they/them, use my name) For information
about pronouns, please see
:
https://urj.org/quick-guide-pronouns
PASSPORT INFORMATION
DATE OF BIRTH.
PASSPORT NUMBER
EXPIRATION DATE.
CITIZENSHIP
FULL CONTACT INFORMATION
HOME ADDRESS
EMAIL
MOBILE
COVID VACCINATION DETAILS
HOW MANY VACCINATIONS WILL YOU HAVE HAD BY THE DATE OF ARRIVAL IN ISRAEL?
Please select...
0
1
2
3
4
DATE OF LAST VACCINATION
VACCINATION
(i.e Pfizer, Moderna, Johnson & Johnson etc.)