Gateway To Israel Pre-Registration Form
We are excited for our second-ever trip to Israel, a trip designed specifically for individuals with disabilities. Together on this 10-day journey, we will explore Israel’s history, spectacular cities, dynamic people, vibrant art and culture, world-class scientific and medical achievements, and natural beauty. We ask all participants bring a companion on the trip.

Trip Dates: May 8 - 18
Cost: $1,500
Airfare is an additional cost and purchased separately.
A $500 deposit to be paid by January 26, 2018 per person to hold your spot.

The above price includes:
• Breakfast plus lunch or dinner
• Tips for the tour educator and bus driver
• The prices are based on double occupancy rooms at the hotels and guests can request a single room for an extra $850.

Highlights of the trip include:
• Experience the Old City of Jerusalem and the Kotel (Western Wall)
• Ascend to the top of Masada, the ancient fortress, by cable car
• Get your hands dirty at the Mechane Yehuda Fruit and Vegetable Garden
• A dip in the Dead Sea and an archeological dig at Beit Guvrin National Park
• A visit to the Knesset, Israel’s parliament
• Get to know the “Special in Uniform” unit of the Israeli Military

The group will be accompanied by the EDCJCC’s Director of Inclusion and Disability Programming and an additional EDCJCC Staff. All participants must bring a companion on the trip with them.

Contact Stacey Herman, Director of Inclusion and Disability Programming at Staceyh@edcjcc.org with any questions.

This subsidized trip is in partnership with JCC Association.

Email address *
Last Name (Participant) *
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First Name (Participant) *
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Please Provide your date of birth *
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Your Phone Number
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Please provide the name of the person you plan to bring on the trip with you. *
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Please Provide the email of the person you plan to bring on the trip with you. *
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Please Provide the phone number of the person you plan to bring on the trip with you.
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First and Last Name for Emergency Contact Information *
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Phone Number of Emergency Contact *
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Email of Emergency Contact *
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Do you have any dietary restrictions? *
Do you have any allergies? Please List *
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If applies, please explain any sensory sensitivities that we should be aware of.
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If applies, please explain any social anxiety that we should be aware of.
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If applies, please explain any physical limitations
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What challenges do you have when traveling?
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What do you love most about traveling?
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How do you plan on arriving/departing Israel *
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Do you have a current passport that will not expire in the next year? *
I understand the cost per person is $1500 (this does not include airfare.) *
I understand airfare is a separate cost per person. *
I understand to hold my place on the trip I must submit a deposit of $500 per person by Friday, January 26, 2018. *
I have all intentions to attend on the trip May 8 - 18, 2017. *
I have not yet received an itinerary for the trip and would like to receive one.
Please list any other information that you think would support you as we plan for the Gateway to Israel trip.
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