The Jewish Center Poland Trip Registration Form
Primary Guest Information
Title *
First Name (as it appears on your passport) *
Your answer
Middle Name (As it appears on your passport) *
Your answer
Last name (As it appears on your passport) *
Your answer
Gender *
Number of people you are registering for *including yourself* *
Which piece(s) of the trip are you registering for? *
Required
Email *
Your answer
Phone *
Your answer
Cell Phone (for group Whatsapp communication during the trip) *
Your answer
Home address: *
Your answer
City, State, ZIP, Country *
Your answer
Passport Information
Passport Number: *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Passport Expiration Date *
MM
/
DD
/
YYYY
Nationality (as listed on your passport): *
Your answer
Trip Information
Emergency Contact: Name, Phone, Relationship *
Your answer
Do you give your consent to having your email address/phone number shared with the rest of the participants on the trip for group emails before, during and after the trip? *
Do you have problems standing or walking for long periods of time? *
Do you have any dietary requirements? *
If yes, please explain:
Your answer
Registration Information
All prices are based on double occupancy (2 guests per room). If you would like a single supplement please click here.
If you are registering for 1 guest and would like to be placed in a double occupancy room, please tell us who you'd like to room with.
Your answer
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