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"Never in the field of
human conflict, was
so much owed by so
many to so few"

Winston Churchill

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On-Line Registration Form

Please read carefully the
Download a hardcopy form, fill and send it to us
Or fill in the fields, and press the SEND button when you finish. You will be contacted separately for the payment considerations.

Mrs

Rabbi

First Name:

Last Name:

Date of Birth:

Street:
City:
Country:
Zip Code:

Home Phone:
Work Phone:
Fax No.:
Cell Phone:
E-Mail:

Passport No.:
Issuing Country:
Issue Date:
Exp. Date:

Room Arrangements:

Single - additional charge $870

Double - I will share room with:

Roommate:

Smoking

Non smoking

Name on Badge:

Size of T-Shirt:

Small

Medium

Large

X-Large

Allergies or Special Medical Conditions:

Special Dietary Restrictions:

Tour Costs:

Fill in the blanks according to your needs, total, and include payment!

Chapter	Price per Unit	Your Payment
Land Package	$2,385
Minimum Contribution	$1,000
Single Room Suppliment	$870
Additional Nights - Double	$312 per night
Additional Nights - Single	$290 per night
VIP Arrival Transfer	$122 up to 4 persons
VIP Departure Transfer	$122 up to 4 persons
TOTAL COST
Deposit	$250 non refundable
Balance	Due in full by May 15,2009

After you will send the form, an IAFC Foundation representative will be in touch with you to oversee the payment method and details.

Relatives or friends to be contacted in case of emergency while on tour:

Name:		Relation:
Home phone:		Work phone:

Name:		Relation:
Home phone:		Work phone:

I have personally spoken to the listed emergency contact person and in the event of accident, injury, illness or death I hereby authorize them to handle any and all arrangements associated with transporting me and/or my remains in accordance to my specific instructions to them prior to my departure for this tour.

Further, I have communicated with same and made the necessary financial arrangements, should it need to arise, to transport me or my remains respectfully. I hereby release Amiel Tours Ltd. and its representatives of any liability associated with any loss, accident, injury or death.

Date:

Signature:

Flight Arrangements:

Flights are not included in the package price. For assistance with your flight arrangements, please contact:

Yael or Claudia - Gama Tours,
Phone: +1 (561)-613-6000

If you have made your own flight arrangements, please fill in the requested information below:

Flight to Israel:

Departure City:
Departure Date:
Departure Time:
Airline:
Flight #:
Arrival time at Ben-Gurion:

Return Flight from Israel:

Airline:
Flight #:
Departure Date:
Departure Time:

Insurance Optional :

Trip Cancellation, Baggage, Hospital/Medical Insurance Package is highly recommended. Cost of insurance is age-related and must be purchased at time of registration.

I have been offered insurance and I decline its purchase:

Date:

Signature:

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For Help in Registration and More Information
Contact our Mission Coordinator:
Hindy Komin
Phone: +1 (212) 5322777
E-Mail: hindy@iafc-usa.com