LSC 2018 Mission to Israel

2018 Mission to Israel

Join us in celebrating 70 years of Israel’s independence.

April 15-22, 2018

(* = required fields)

Your Personal Information

First Name (as it appears on passport)

Middle Name (as it appears on passport)

Last Name (as it appears on passport)

Date of birth

Gender

Have you traveled to Israel before?

Approximately how many times have you been in Israel?

Last time in Israel

Connection to a lone soldier

Other

Your Contact Information

Home Street Address

City

State

Zip Code

Email Address

Province

Country

Cell Phone # (numbers only)

Home Phone #

Emergency Contact Information

First Name

Last Name

Relationship

Street Address

City

State

Province

Zip Code

Country

Home Phone #

Cell Phone # (numbers only)

Email Address

Special Requests

Dietary Needs

Allergies (please list relevant allergies)

Other (please list anything else we should know about or take into consideration

There is a non-refundable registration fee of $500.

Remaining balance must be made by Feb. 2018.

The total cost of the program for double occupancy is $3,200 per person.

For single occupancy, the cost is $3,900 per person.

(prices include the registration fee)

The program cost will cover all food, board, events and activities for the duration of the mission.

Program participants are responsible for arranging their own flights to and from Israel.

Payment amount:

$500 - Non-refundable registration fee$3,200 per person for double occupancy$3,900 per person for single occupancy

Payment Information

Name on Card

Card Number

Expiration Month

Expiration Year

CVC Code

Need assistance with this form?

	HeChalutz 29 Jerusalem, 9622226
	(02) 502-2211
	info@lonesoldiercenter.com

	38 King George, Tel Aviv 5th Floor
	03-560-1931
	info@lonesoldiercenter.com