THE J² REGISTRATION FORM.
PLEASE COMPLETE THIS FORM FOR EACH TRAVELER. A J²REPRESENTATIVE WILL BE IN TOUCH TO SHARE MORE INFORMATION AND COLLECT MORE DETAILS CLOSER TO THE TRAVEL DATE.

TRIP NAME

ATJC Goes to Israel with Rabbi Jonathan Berkun

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

PLEASE ADD YOUR ROOM PREFERENCE: SINGLE, DOUBLE, TWIN, CONNECTING, ADJOINING, AND ADD NAMES OF OTHER(S) SHARING YOUR ROOM.

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?

DATE OF LAST VACCINATION

VACCINATION (i.e Pfizer, Moderna, Johnson & Johnson etc.)