Registration for The Holy Land; March 2 - 11, 2013

Name: *

(Exactly as it appears on your passport.)

Name: *

(As you would like it to appear on name tag.)

Address: *

City: *

State: *

Zip: *

Country: *

Country in which passport was issued: *

Passport Expiration Date: *

Passport Number: *

Date of Birth: *

E-mail: *

Home Phone: *

Cell Phone:

Work Phone:

T-Shirt Size: *

Your Age Range: *

Base Cost of the Holy Land Trip: $3495*

City you will be traveling from (Add-on City):

Optional Travel Insurance: $189.00: *

yes

no

Optional Single Supplement: Price $699: *

(limited number available)

yes

no

Name(s) of traveling companions:

Name of roommate (if applicable):

Do you have any special travel or dietary needs?:

If yes, please explain, or include additional information

*Payment needs to be received in full by January 2, 2013. $500.00 deposit is due at the time of your registration.

**Deposits may be made by personal check, Visa, Master Card, or Discover. Additional payments must be made by check or money order.