ONLINE MISSION REGISTRATION FORM

Please fill ONLY one name per form:
First Name   Last Name
Name on Passport  
Passport #
   Issue Date   DOB
El Al Matmid #
Street Address   CITY
City      State        Zip

Home Phone #  Cell Phone #   Work Phone # Best # to reach you during the day
Fax  
  E-mail*
Rooming Options  double       single(please add $565 to the price)      triple
Please room me with

Please bill me for  air and land for $2654 plus $95 for airport tax plus $250 for airport tax totaling $2999, airport tax and fuel surcharge are subject to change.
I am going with the group both ways.
I want to depart separately  on (date)
I want to return separately on (date)
I want land only for $2010

I will send a Non refundable deposit of $250 in the form of a check by mail.
I will pay $260  online by credit card (with 4%  processing fee)

All deposits must be in by July 31 to avoid the price increase of $100 on August 1st.

 

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