Premium Tour

Congregation Beth Shalom, Holy Mission to Israel 2025 Registration

Contact us for any questions at:  [email protected]

Name
(as you would like to be called on the trip)
First Name *
Last Name *
Name
(as appears on passport)
Passport Number *
Passport Expiration Date *

CONTACT INFORMATION

Street
Address line 2
City

State/Province
zip postal code
Country
Cellphone *
Email Address *

SPECIAL REQUIREMENTS

Food Preferences *
Do you have any accessibility requirements or physical limitations or restrictions? *
Please give us a detailed description of your requirements
Do you have any special dietary requirements or allergies? *
Please list your dietary requirements or allergies:
Are you currently taking any medication that we should know about? *
Please list:
Do you want to add a person?

COMPANION INFORMATION

Companion Name
(as you would like to be called on the trip)
First Name *
Last Name *
Name
(as appears on passport)
Passport Number *
Passport Expiration Date *

COMPANION SPECIAL REQUIREMENTS

Food Preferences *
Do you have any accessibility requirements or physical limitations or restrictions? 
Please give us a detailed description of your requirements
Do you have any special dietary requirements or allergies?
Please list your dietary requirements or allergies:
Are you currently taking any medication that we should know about?
Please list: