LSC Housing Form – The Lone Soldier Center in Memory of Michael Levin

Parent/Guardian Information

Which parent(s) are you in touch with?

Mother’s First Name

Mother’s Last Name

Mother’s Phone

Mother’s Email

Father’s First Name

Father’s Last Name

Father’s Phone

Father’s Email

Contact in Israel’s Information

Please Enter your Israel-based emergency contact’s information (a family member, close friend, or someone you like/trust)

First Name

Last Name

Phone

City of Residence

Military Information

Military ID #

Army Unit

Army Position

Other Unit

Draft Date

Please enter the date using the calendar or dd/mm/yyyy. If you do not have a draft date, please enter an estimated date of when you expect to draft.

Release Date

Please enter the date using the calendar or dd/mm/yyyy

Army Program

MachalGarin TzabarNone

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