Beth El Encounter Intensive Seminar

Name




Contact Information








Please enter any non-US phone numbers in international format e.g. +972 2 555 5555 extensions and one-word descriptions are also allowed e.g. 212 555 5555 x123 (office)

Please enter any non-US phone numbers in international format e.g. +972 2 555 5555 extensions and one-word descriptions are also allowed e.g. 212 555 5555 x123 (office)

Please enter any non-US phone numbers in international format e.g. +972 2 555 5555 extensions and one-word descriptions are also allowed e.g. 212 555 5555 x123 (office)

Please enter any non-US phone numbers in international format e.g. +972 2 555 5555 extensions and one-word descriptions are also allowed e.g. 212 555 5555 x123 (office)
Basic Information



Current Affiliation


Jewish Denominational Affiliation
Encounter strives to represent the diversity of the Jewish community on our programs. Help us track one facet of that diversity by selecting the Jewish denominational affiliation that best matches your practice.



Program

Your thoughtful responses to the questions below will help us to get to know you and your leadership opportunities and challenges. The questions are intentionally open-ended; we invite you to share as much texture as you are willing.

We thank you in advance for your time and honest answers.





Travel Information

Note: Israeli law forbids individuals with Israeli citizenship from traveling to Area A of the West Bank, which is under the full auspices of the Palestinian Authority. Israeli citizens may enter Area A with an approved permit from the Israeli Civil Administration, the Israeli governing body which operates in the West Bank. The Civil Administration is a part of a larger entity known as Coordinator of Government Activities in the Territories (COGAT), which is a unit in the Defense Ministry of Israel. If you hold Israeli citizenship, please note that here and if selected for the program, a staff member will discuss with you.





Your wellbeing is of utmost importance to us, especially during the travel component of our program. It is important that you share with us any relevant medical information in the event of an emergency in which we need to care for you. All information will be kept confidential.

Emergency Contacts
Emergency Contact 1




Please enter any non-US phone numbers in international format e.g. +972 2 555 5555 extensions and one-word descriptions are also allowed e.g. 212 555 5555 x123 (office)

Please enter any non-US phone numbers in international format e.g. +972 2 555 5555 extensions and one-word descriptions are also allowed e.g. 212 555 5555 x123 (office)

Emergency Contact 2





Please enter any non-US phone numbers in international format e.g. +972 2 555 5555 extensions and one-word descriptions are also allowed e.g. 212 555 5555 x123 (office)

At the end of each day, a brief communication will be sent out to emergency contacts with an update on the group’s activities and the itinerary for the following day.

Trip Accommodations



Davening

For planning purposes, please indicate your davening preference.





Page 4

Participant Agreement

To confirm your participation, you will need to check the appropriate boxes confirming that you have read and agree to each section of this document.










I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THE FOREGOING AGREEMENT, UNDERSTAND THAT THIS AGREEMENT IS A BINDING LEGAL INSTRUMENT AFFECTING SIGNIFICANT RIGHTS, AND I SIGN THIS AGREEMENT VOLUNTARILY, KNOWINGLY AND WITHOUT COERCION. BY TYPING MY NAME IN THE BOX BELOW, I AGREE TO ALL OF THE ABOVE.


Additional Comments