Israel Tour Registration A $500 non-refundable deposit is required with your tour registration. Full Name Preferred Name (optional) Are you male or female? Male Female Which tour are you registering for? March - April November Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Cell Phone NumberEmail Address Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age Country of Birth Roommate Request Do you have a current passport with an expiration date that is more than six months beyond the trip dates?* Yes No If you do not have a current passport, it is very important you apply as soon as possible at the Post Office, and notify HHI as soon as you have received your passport.Name as it Appears on Passport Expiration Date Passport Number Emergency Contact Name Relationship to You Contact's Phone Number Present State of Health Excellent Good Average Poor Are you under any medical restrictions or do you have any medical issues that would affect your participation in this trip?If yes, please explainList all medications (prescribed or over-the-counter) that you are taking:List Any Allergies You May HaveToday's Date* MM slash DD slash YYYY
