The Extreme Israel Experience Registration


Places are limited!
Send your information now so you can start the registration process and
get ready to see Israel… in the extreme!
Step 1 --> Personal Information

Name: *
Email: *
Home Address:

City: State: Zip:
Phone: Fax: Mobile:


Step 2 --> Traveling Information

Passport Number: *
Passport Expiration Date: * (day/month/year)
Date of Birth: * (day/month/year)
Passport Issuing Country: *
Dietery Restrictions:



Rooming: Double**
Triple
Two Rooms
**Double rooms are available upon request, but are subject to availability (first come, first serve):
Double Room (an additional $100 to trip cost)

Which trip do you want to join? December 30th 2007 – January 11th 2008


Step 3 --> Check and Submit

Please go over the form you just filled out and check that all the information is correct.
After you have finished filling out your registration, you will be taken to a page explaining the second part of the process.
There you will be able to go to our payment site to pay your fully refundable* deposit of $250.

*refundable up to 60 days before the program, after which there is no refund.


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