PAS Adult Learning Israel Trip 2011 - Park Avenue Synagogue

TRIP REGISTRATION FORM
PAS Adult Learning Israel Trip May 28 – June 6, 2011
Please return this form, along with a deposit of $250 per person, to Cindy Sherling at Park Avenue Synagogue by February 15, 2011. Deposits are
refundable until April 15. Please make checks payable to “Park Avenue Synagogue” and write “Adult Learning Israel Trip 2011” in the memo line.
Family Name Date
Traveler #1
Name
Address
Phone # / email address
Date of Birth
Place of Birth / Nationality /
Passport #
Origin of Passport / Exp. Date /
Traveler #2
Name
Address
Phone # / email address
Date of Birth
Place of Birth / Nationality /
Passport #
Origin of Passport / Exp. Date /
Traveler #3
Name
Address
Phone # / email address
Date of Birth
Place of Birth / Nationality /
Passport #
Origin of Passport / Exp. Date /
Traveling with the Group?
Part 1: General Information
Part 2: Air Arrangements
I/We are traveling with the PAS Group. We have called/will call Riva at OKT Travel to book the following Group Tickets:
Traveling on your own?
Number of tickets on the May 25 group flight: ________ coach ________ business
Number of tickets on the May 28 group flight: ________ coach ________ business
Number of tickets on the June 6 group flight: ________ coach ________ business
I/We are traveling on our own. We are planning to arrive at the Inbal Hotel in Jerusalem by 6:45 pm on Sunday, May 29, 2011. Our flight arrangements are as follows:
To Israel
Airline, Flight #, Departure and Arrival Times:
Returning to New York
Airline, Flight #, Departure and Arrival Times:
Please provide an emergency contact in the U.S.
Contact
Name
Address
Phone # (home and/or cell)
Relation to you
Part 3: Emergency Contact