Israel Study Tour & Pilgrimage | Jerusalem Biblical Studies Society

Passenger name as in passport*

Prefix First Last

Gender*

Date of Birth*

Name on Tour Name-tag*

Mobile Phone Number*

Email*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Passport Number*

Country of Passport*

Country

Passport Expiration Date*

Please upload your passport scan.*

Max. file size: 1 GB.

Air Travel Arrangements:*

I will arrange my own flights

Please arrange flights for me

Frequent Flight Number

(Optional) Flight details (if self-arranged)

Medical and physical matters that we should be aware of:*

Medical Insurance*

I am responsible for my own medical insurance related to this trip.

Please upload your medical travel insurance*

Max. file size: 1 GB.

Emergency Contact*

First Last Relationship

Emergency Contact Phone Number*

Emergency Contact Alternate Phone Number

Roommates*

Try to match me with roommate(s)

I wish to have a single room

Roommates

Have you already paid the deposit?*

Yes

No

Deposit Amount Paid

Payment (Deposit Amount)