Reservation

space(s) on the mission. A deposit of USD $500 minimum per person is required. 

StandWithUs reserves the right to limit participation based upon eligibility requirements and availability. 

General Information

Participant 1

If other, please specify:
Full name exactly as shown on passport:
Name as you'd like it on name tag:
Nationality:
Country of Birth
Date of Birth
Passport Number:

Please note that your passport must be valid for 3 months from the date of your return. 

Country of Issue for Passport:
Passport Expiration Date:
Participant 1 - Occupation
Name of Business/Company:
Cellphone
Email
Important Medical Information

(Handicaps, allergies, medications, or medical condition(s) that we should be aware of)

Religious Affiliation - If other, please specify which:
If so, please state which:
Please describe your communal involvement (if any), and the charities you are involved with or that you care about:
Please tell us why you have chosen to join this Mission:

Participant 2

If other, please specify:
Full name exactly as shown on passport:
Name as you'd like it on name tag:
Nationality
Country of Birth:
Date of Birth:
Passport Number

Please note that your passport must be valid for 3 months from the date of your return. 

Country of Issue for Passport
Passport Expiration Date:
Occupation
Name of Business/Company:
Cellphone:
Email
Important Medical Information

(Handicaps, allergies, medications, or medicatal condition(s) that we should be aware of)

Religious Affiliation - If other, please specify which:
If so, please state which:
Please describe your communal involvement (if any), and the charities you are involved with or that you care about:
Please tell us why you have chosen to join this Mission:

Emergency Contact

Name
Relationship
Address
Telephone:
Cellphone
Email

Emergency Contact 2

Name:
Relationship
Address
Telephone:
Cellphone:
Email

Your health and security is a priority for StandWithUs. Please forward us a copy of your medical/travel insurance policy, together with a current passport-sezed photograph, for our records, at least 21 days before start of traveling to Israel. 

 

By submitting this application you are accepting:

  • The responsibility for sufficient medical coverage for the duration of your stay in Israel. 
  • You have read and accepted the Terms and Conditions including StandWithUs' cancellation policy and take responsibility for purchasing insurance to cover cancellation costs not covered by StandWithUs as per above. 

Payment

Quantity
Price
Total
Deposit
X
$
500.00=
$
0

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code