MYC Israel Discovery and March of the Living Trip- Summer 2014
THE TRIP IS CURRENTLY SOLD OUT. ALL NAMES FROM THIS POINT WILL BE ADDED TO THE WAIT LIST.

Please fill out all of the information below. Please note that this information will be used when issuing your tickets, therefore exact spelling of the First, Middle, and Last name is very important.

Tentative Dates: June 26 to July 15
Total Aprox Price: $4150

PLEASE NOTE: If you do not have your passport information, please put N/A in that field and provide it to us later.

If you have any questions please contact Carolina Aziz at 516-640-6961 or Yosi Nassimi at 516-850-8750
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First Name *
Last Name *
Sex *
Date of Birth *
ex: MM/DD/YYYY
Street Address *
City *
Zip Code *
Home Telephone Number *
ex: 516-555-5555
Participants Cell Phone Number *
ex: 516-555-5555
Parents Name *
Parents Cell Phone Number *
ex: 516-555-5555
Participants Email Address *
NOTE: This email address is where all of your information will be sent
Parents Email Address *
NOTE: All information will be sent to this email
Current Grade *
School *
Passport Number *
Passport Expiration Date *
IMPORTANT: Your passport must be valid through March 2015
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