Enrollment and Participant Information Form for Israel
Upon completion of this form, your deposit is required to secure your registration. Until your deposit is received, your enrollment is not confirmed. Once your deposit is received, you will receive a confirmation letter via email.
T # *
Your answer
Personal Information
Enter your name exactly as it appears or will appear on your passport.

> Be sure to include any suffix (Jr, Sr, III) exactly as printed on your passport.
> Name change fees will apply if you submit incorrect information.

First Name *
Your answer
Middle Name
Enter your full middle name or middle initial exactly as it appears on your passport. If there is no middle name on your passport, leave this box blank.
Your answer
Last Name *
Your answer
Gender *
Birthdate *
format mm/dd/yyyy
Your answer
Profession *
This information may be required on some visa applications.
Your answer
Mailing Address *
Street address, City, State, Zip code
Your answer
Daytime phone *
format xxx-xxx-xxxx
Your answer
Cell phone
Your answer
Email address *
Used for registration confirmation, invoicing and correspondence related to program participation
Your answer
Passport Information
Most countries require passports to be valid up to 6 months after the scheduled return.

Do not enter expired passport information as your passport number will change when you apply for renewal.

Citizenship *
Non-U.S. citizens are responsible for ensuring that they meet the passport and visa requirements of the countries visited.
Your answer
Passport Number *
Enter APPLYING if you are applying for a new passport or renewing an expired passport. If applying or renewing passport, we must have your passport details no later than 90 days prior departure to manage your airline reservation.
Your answer
Issue Date
Your answer
Issuing Authority
Your answer
Expiration Date
Your answer
Place of Birth *
Your answer
Additional Information
Room Type *
In most international destinations, queen and king beds are not available and a double bed may be two twin beds side-by-side. Single (1 bed) at supplemental cost.
Roommate Name *
Single supplement applies if no roommate listed or type "roommate wanted" and, if available, we will accommodate your request. Type single if single room is requested.
Your answer
Special Meal Requests
We will advise the airline and/or restaurants of special requests, but cannot guarantee to accommodate all requests. Please note any food allergies in the Other box.
Health/Physical Conditions Impacting Your Participation
This tour requires significant walking with an active group of traveling companions, including uneven ground and stairs, which may not have railings. Tours are not designed for wheelchair, scooter or walker accessibility. Be advised the Americans with Disabilities Act is inapplicable outside of the United States, and facilities outside the United States, such as ramps, elevators and hand railings are may be limited. Describe any health or mobility conditions (use of cane, use of oxygen, etc.) that may limit or impact your participation on this program. Accessibility for people with disabilities varies significantly from country to country, and participants with special needs may incur surcharges for additional services.

Please advise if you want to request an accessible room (not guaranteed), or if you wear hearing aids so we may order an adapter for any use of audio headsets.

Seminars International, in consensus with the tour hosts and our destination partner, reserves the right to not accept or withdraw any participant whose conduct or ability to participate is incompatible with the operation of the tour or the interests of the group as a whole.

Health/Physical Restrictions and Requests
Your answer
Frequent Flyer Airline Code
AA-American Airlines, AF-Air France, BA-British Airways, DL-Delta Air Lines, FI-Icelandair, KL-KLM, LH-Lufthansa, UA-United Airlines
Frequent Flyer Number
NOTE: Airlines may limit mileage credit on contracted group fares. If # is unknown at this time, you can provide the number to the check-in agent at the airport.
Your answer
Flight Arrangements:
Early departure from the U.S. is not permitted. Upgrading using frequent flyer mileage is not allowed on contracted group airfares. Some airlines are now offering enhanced seating options within economy class. These options may only be secured approximately 30 days prior to departure on a group booking and may no longer be available at that time.

If an enhanced economy seat or early departure is a high priority, please consider registering for the land only program and purchasing your own air ticket. The number of land only spaces is limited, availability will be confirmed and additional information provided after submitting this form.

Flight Details *
(select one and use the comments section to provide additional details.)
Your answer
If you have Global Entry or TSA Pre-Check, please provide the number in the comment box above.
Emergency Contact Name *
Your contact person should be someone who is not traveling with you. Enter at least one phone number for your contact person.
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Home Phone
Your answer
Emergency Contact Office Phone
Your answer
Emergency Contact Cell Phone
Your answer
Emergency Contact Email
Your answer
Deposit Confirmation and Email Contact
Upon receipt of your deposit, you will receive a registration confirmation via email from seminarsinternational@semint.com. We suggest that you add seminarsinternational@semint.com to the contact list in your email address book to ensure you receive all correspondence regarding this program.
Travel Advisory Waiver for Israel, West Bank and Gaza
I understand that there are inherent risks involved with traveling and living abroad, and I acknowledge and accept all of these risks. These risks include travel to and within, and returning from, one or more foreign countries; foreign political, legal, social and economic conditions; local medical conditions and local weather conditions. These risks also include the risk of violence and terrorist activity.

In 2000, the U.S. State Department issued a Travel Warning for Israel, West Bank and Gaza. In 2018, this system for presenting travel conditions has changed to a Travel Advisory with Levels of 1 to 4. I specifically acknowledge that I have read the Travel Advisory for Israel, the West Bank and Gaza available on the website of the U.S. Department of State.

Further, I hereby release, covenant not to sue and forever discharge the tour host, Seminars International and nay of its or their trustees, officers, agents, employees and volunteers of any and all claims, demands, rights and causes of action of whatever kind of nature, including but not limited to negligence, unforeseen bodily and personal injuries, damage to property and the consequences there of resulting from participation in this program and/ or any travel incident there to.

Waiver of Responsibility
Seminars International Inc., acts only as an agent and neither Seminars International Inc., nor any employee or appointee nor any other person, party or organization or agency collaborating with them is or shall be responsible or liable for any injury or loss, accident or damage, delay or deviation or curtailment, howsoever caused or arising, or the consequences thereof, which may occur during any part of the travel or program or during such free time as the members may elect to spend independently on the tour. The airlines or commercial carriers concerned are not to be held responsible for any acts, omissions, or events during the time the passengers are not on board their planes or conveyances. The passage contracts, in use by the airlines concerned, when issued, will constitute the sole contract between the airlines and the purchaser of this tour/or passenger.
Medical Release
I, the undersigned, hereby give my permission for Seminars International Inc. to procure all necessary medical help for myself, my child or ward while said person is under the direct supervision of Seminars International Inc. and grant permission to its representatives to authorize any competent medical person to do all things reasonably necessary to take care of any injury or sickness.

By clicking SUBMIT, I acknowledge that I have read and understand the Waiver of Responsibility, the Medical Release and the Statement of Conditions as stated on the brochure and consent to the use of my image and photograph in any Seminars International publication, marketing materials and website.

Personal Data Acknowledgement Statement
Seminars International is committed to protecting the privacy of program leaders and participants. We collect personal data from leaders and participants in order to operate programs safely and responsibly.

By clicking SUBMIT, you accept that personal data collected here will be shared with program leaders and sponsoring universities/institutions and will be used to make travel arrangements on your behalf (including air and land bookings). We may also contact you in an emergency. Leader information will also be used to enroll them in the US Department of State STEP program.

The Seminars International Privacy and Data Security Policy, can be reviewed on the Home page of our website, www.semint.com.

Please print a copy of your completed form for your records before clicking submit at the end of this document.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service