Israel 2021 Nurturing Faith Experience Registration 2021 ISRAEL/WEST BANK December 31, 2020 - January 10, 2021 Name*Name as it appears on passport. (If no passport, use your full name and get the passport as soon as possible, using the same name). NOTE: The U.S. restricts some military and government employees (even retired) from traveling to Israel. Please make sure this does not apply to you. First Middle Last Email* Best Phone Number*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth*Must Match Passport Date Format: MM slash DD slash YYYY Passport Number*Passport Issued From (Country)*Passport Expiration Date* Date Format: MM slash DD slash YYYY Frequent Flier Number(s) (United Airlines or Star Alliance)Flight Seating PreferenceOptional: Do you wish to sit beside a particular person? Do you prefer an aisle, window, or middle seat? (We cannot guarantee that the airline will honor your request.) Do you have any dietary restricitons we should be aware of?We can ask the airlines for vegetarian, gluten-free, or lactose-free meals.Rooming Requests (If applicable)Today's Payment*Payment Options Available: 1) Deposit 2) Full PaymentDeposit for 2 people (Dbl Occupancy): $1,600Deposit for 1 person (Dbl Occupancy): $800Deposit for 1 person (Single Occupancy): $800Pay in full for 2 people (Dbl Occupancy): $8,700Pay in full for 1 person (Dbl Occupancy): $4,350Pay in full for 1 person (Single Occupancy): $5,150Choose an option.*I want to pay now with a credit card.I will send a check for this payment. I understand that my registration is not secured until payment is received.Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.