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
A Taste of Israel | Beth Sholom Journey To Israel | Led by Rabbi Sam Stern | May 2023
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
ARE YOU A SINGLE TRAVELER?
Please select...
YES
NO
IF YOU ARE NOT A SINGLE TRAVELER PLEASE ADD THE NAME OF YOUR ROOMMATE
IF YOU WOULD LIKE A ROOMMATE BUT DO NOT YET KNOW WHO THAT WILL BE, PLEASE INDICATE "
TBA"
IN PLACE OF THE NAME.
DO YOU HAVE ANY DIETARY RESTRICTIONS OR ALLERGIES ?
EMERGENCY CONTACT NOT TRAVELING ( NAME AND PHONE NUMBER)
PASSPORT INFORMATION
DATE OF BIRTH.
PASSPORT NUMBER
EXPIRATION DATE.
CITIZENSHIP
FULL CONTACT INFORMATION
FULL HOME ADDRESS (STREET, CITY, STATE, COUNTRY)
EMAIL
MOBILE
HOME TELEPHONE #