Apply for Israel Bound

Participant Information
Name as it appears or will appear on passport*
First Middle Last
Nickname (if applicable)
Date of Birth*
Date Format: MM slash DD slash YYYY
Gender*
Participant Email*
Parents will be CC’d on all emails to participants.
Participant Home Phone
Participant Cell Phone
Passport Country
Passport Number
Passport Expiration Date
NOTE: Passport must be valid for 6 months past the scheduled return date – December 21, 2020.
Date Format: MM slash DD slash YYYY
Passport Pending
- Yes
- No
Current Grade*
High School*
Synagogue Affiliation (if applicable)
T-Shirt Size*
- Small
- Medium
- Large
- X-Large
Passport to Israel Participant?*
- Yes
- No

Payment Information
Trip Dates and Pricing
- Trip Dates: June 1-June 21, 2020
- Note: Trip price is all-inclusive (includes round-trip flight from St. Louis)
- $5,675 Early-bird pricing through December 31, 2019
- $6,075 Regular price starting January 1, 2020
Payment Schedule

A $500 deposit is due with this application. On February 7, 2020, an additional $750 payment is due. The remaining balance of the trip is due March 27, 2020.

Passport to Israel, Grants and Scholarships

Passport to Israel funds, grants, and scholarships will be applied to the final payment due March 27, 2020.

Refunds

All payments are fully refundable until February 14, 2020. Following February 14, a $750 cancellation fee applies. After March 27, all program payments are non-refundable. Exceptions will be reviewed by the Jewish Federation of St. Louis on a case by case basis.
$500 Deposit Payment Type*
- Check: Make $500 check payable to the Jewish Federation of St. Louis and mail to Jody Gerth at 12 Millstone Campus Drive, St. Louis, MO 63146
- Credit Card
Application Deposit*
Price: $500.00
Billing Address*
Same as Parent/Guardian 1

Street Address Address Line 2 City State ZIP Code
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Terms of Acceptance
- The parent or guardian certifies that the applicant is currently healthy and able to participate in all Israel Bound activities.
- The parent or guardian grants permission to use pictures in which the participant appears as part of Israel Bound.
- Jewish Federation of St. Louis reserves the right to adjust the price up to 5% based on exchange rate and airline fuel fee fluctuation. Participants reserve the right to cancel and receive a full refund in the event of a price increase if they so wish.
I have read and will understand the terms as outlined on this registration form.
Parent/Guardian 1 Signature*
Parent/Guardian 2 Signature
Comments
This field is for validation purposes and should be left unchanged.

Participant Information