All fields marked with * are required.
1. RESERVATION
Please reserve
1
2
space(s). A deposit of $500 minimum per person is required.
HonestReporting reserves the right to limit participation based upon eligibility requirements and availability. For further information contact our HonestReporting office in Israel:hrmission@honestreporting.com
2. GENERAL INFORMATION
Participant 1
Title:
Mr
Mrs
Ms
Dr
Rabbi
Other
If other, please specify:
* Full name exactly as shown on passport:
* Name as you'd like it on name tag:
Gender:
Male
Female
Nationality:
Country of Birth:
Date of Birth:
01
02
03
04
05
06
07
08
09
10
11
12
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Passport Number:
Country of Issue for Passport:
Passport Expiration Date:
01
02
03
04
05
06
07
08
09
10
11
12
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Please note that passport must be valid for 3 months from the date of your return to the U.S.A.
Business Information:
Occupation:
Name of Business/Company:
Participant 2
Title:
Mr
Mrs
Ms
Dr
Rabbi
Other
If other, please specify:
* Full name exactly as shown on passport:
* Name as you'd like it on name tag:
Gender:
Male
Female
Nationality:
Country of Birth:
Date of Birth:
01
02
03
04
05
06
07
08
09
10
11
12
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Passport Number:
Country of Issue for Passport:
Passport Expiration Date:
01
02
03
04
05
06
07
08
09
10
11
12
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Please note that passport must be valid for 3 months from the date of your return to the U.S.A.
Business Information:
Occupation:
Name of Business/Company:
Help us to help you!
We want to help you get the most out of your trip with us, so go
ahead and help us get to know you. Of course, your privacy is
paramount.
Participant 1
Important Medical Information(Handicaps, allergies, medications, or medical condition that we should be aware of)
Walks of approx 45 minutes and climbing steps are typically part of our program (please see 'Terms & Conditions' for more information). Please let us know if there is any reason why you will not be able to partake in this part of the program:
Religious Affiliation (Please circle one - if other, please state which)
Reform
Conservative
Orthodox
Non-affiliated Jewish
Christian
Other
Have you been to Israel before?
Yes
No
If you answered yes to the above, have you attended a Mission in the past? If so, please state which:
Yes
No
Please describe your communal involvement (if any), and the charities you are involved with or that you care about:
Please tell us why you have chosen to join this Mission:
Participant 2
Important Medical Information(Handicaps, allergies, medications, or medical condition that we should be aware of)
Walks of approx 45 minutes and climbing steps are typically part of our program (please see "Terms & Conditions" for more information). Please let us know if there is any reason why you will not be able to partake in this part of the program:
Religious Affiliation (Please circle one - if other, please state which)
Reform
Conservative
Orthodox
Non-affiliated Jewish
Christian
Other
Have you been to Israel before?
Yes
No
If you answered yes to the above, have you attended a Mission in the past? If so, please state which:
Yes
No
Please describe your communal involvement (if any), and the charities you are involved with or that you care about:
Please tell us why you have chosen to join this Mission:
3. CONTACT INFORMATION
* Address:
* City:
State:
* Zip/Postal Code:
Country:
* Home Telephone:
Work Telephone:
Cellphone:
* Email:
4. EMERGENCY CONTACT
Contact 1
Name:
Relationship:
Place of Work:
Title:
Address:
Telephone:
Cellphone:
Email:
Contact 2
Name:
Relationship:
Place of Work:
Title:
Address:
Telephone:
Cellphone:
Email:
5. BOOKING REQUIREMENTS
Number of rooms required:
0
1
2
3
4
5
6
7
Please select which type of room you would like to book:
(additional charge of ($40 per night) ($60 per night) ($80 per night) ($90 per night) (price upon request)
Special Requirements:
Special Dietary Requirements:
Physical Limitations or Restrictions:
Note: When possible HonestReporting will attempt to find suitable roommates, if requested. However, if we are unsuccessful, participant will be subject to the single supplement charge.
6. PAYMENT
I will be sending my payment by:
Paying Online with my credit card (see below)
Contacting you with my cc info
Mailing in checks
Please send your deposit of $500 per person as soon as possible.
Click our HR Donation page
If you choose paying online, please click the 'Other Single Payment Amount' option and enter $500 (per person), then continue normally.
Any other comments/requests:
Your health and security is a priority for HonestReporting. Please forward us a copy of your medical/travel insurance policy, together with a current passport-sized photograph, for our records, at least 21 days before the start of travelling to Israel.
I/We take responsibility for sufficient medical coverage for the duration of my/our stay in Israel.
I have read and accepted the Terms and Conditions
