MARCH OF THE LIVING: An Initiative of Sinai Temple Sisterhood
Dear Applicant,

The full cost of the trip is $4,000 per person for Sinai Temple Members, and $4,300 for non-Sinai Temple Members, based on double occupancy. All payments are now non-refundable. The cost covers all land fees in Poland: Deluxe hotels throughout Poland, all entrance fees, gratuities, fully guided w/historian (including headset), luxury motor coach, designated security guard at all times, VIP Kosher meals daily including some dinners at local restaurants (except for free time meals on your own), participation in the March of the Living on Yom HaShoah (Holocaust Remembrance Day) in Poland, optional participation in the March of the Living parade in Jerusalem and main event on Yom HaAtzmaut, touring to various sites in Poland, March of the Living jacket and backpack.

Please note that flights between the US and Poland are not included and should be booked on your own.

An additional $1,125 can be paid for a single occupancy room.

As you fill out the following application, please be assured that all information will be protected by The International March of the Living and Sinai Temple.

An application must be completed by each individual and will need to be completed in one sitting.

Refund & Cancellation Policy:
The deposit is fully refundable if cancelled prior to October, 30, 2018. After November 1, the deposit is not refundable. If cancellation occurs between December 1, 2018 and January 15, 2019 an administration fee of $1500 per person will be assessed. If cancellation is between January 16, 2019 and February 15, 2019, an administration fee of $2500 will be assessed. There are no refunds after February 16, 2019.

Have your health insurance card, emergency contact information, passport number and expiration date available prior to beginning the application. (If you do not have a passport or need to renew it, you will be able to complete the application by following the instructions in the passport section)

You can submit payment via check made out to "Sinai Temple Sisterhood". Write the name of the applicant and "MOTL Adult" on the bottom of the check. If you prefer to pay via credit card, you can do so below. Please note the 3% service charge for payments by credit card. This applies to deposit and balance.

Upon payment, please submit a copy of the front page of your passport ASAP.

Mail items to:
Sinai Temple
Attention: March of the Living
10400 Wilshire Blvd
Los Angeles, CA 90024

Once your application is submitted, you will receive an email with confirmation.

We highly recommend that you purchase trip cancellation and travel insurance.

Questions? Email Rebecca Kekst at rebeccakekst@me.com (310) 739-1078 Or Adeena Fitterman adeena@fittermanfamily.com or call 310.440.0401

Email address *
PERSONAL INFORMATION
Last name (as it appears on your passport) *
Your answer
First name (as it appears on your passport) *
Your answer
Middle name (as it appears on your passport) *
Your answer
Hebrew Name
Your answer
Date of Birth *
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DD
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YYYY
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Country of Residence *
Your answer
Cell Phone *
Your answer
Home Phone
Your answer
Marital Status *
Spouse/Partner Name (If Applicable)
Your answer
With which denomination of Judaism do you most identify?
Your answer
Are you a member of Sinai Temple? *
If not, what is the name of the Synagogue you belong to?
Your answer
List your Jewish Organizational Affiliations:
Your answer
Are you or any of your immediate family members survivors of the Holocaust? *
If yes, please list your relationship, their names and where they were from:
Your answer
Did you lose any close family relatives in the Holocaust? *
If yes, please list your relationship, their names, where they were from and where they were murdered:
Your answer
Have you been to Poland before? *
Have you been to Israel before? *
What languages do you speak? *
Required
PROGRAM & FLIGHT INFORMATION
Alice and Nahum Lainer School of Sinai Temple March of the Living program is one week in Poland. The cost of the program includes land only while in Poland. Flights from USA to Poland and back to the USA are the responsibility of each individual participant.

All fees are based on double occupancy, with a minimum of 35 participants.

For an additional fee, there is an option to catch a one-way flight from Poland to Israel, however, please note this option does not include hotels, meals, programming while in Israel, or the return flight to the USA.

Additionally, there is an option to participate in the Yom Ha'atzmaut March in Jerusalem and BBQ in Latrun.

Program applying for *
Additional Services - Contact us for Pricing Info *
Roommate Preference Poland *
For Double Occupancy *
Name of Preferred Roommate (if applicable)
Your answer
What size March of the Living jacket would you like? [Men's sizing - run large] (Subject to availability) *
What size t-shirt would you like? (Men's sizing) *
PASSPORT INFORMATION
IMPORTANT: In order to depart the US, Homeland Security requires that you have a valid passport that is valid for at least six months after the trip; accordingly, be sure that your passport expires after November 07, 2019. If it expires prior to that date, you will need to renew your passport now - do not wait. If you are awaiting a new passport, enter your old passport number or 123456789 as your passport number and your expiration date or 11/12/2019 as your expiration date. As soon as you receive your new passport, submit the inside page to us so the information can be corrected in our system.
Primary Country of Citizenship *
Your answer
Name as it appears on your Primary Passport *
Your answer
Primary Passport Number *
Your answer
Expiration Date of Primary Passport *
MM
/
DD
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YYYY
Are you a Citizen of Israel? (If yes, please note that you must enter Israel on your Israeli Passport) *
Israeli Passport Number (If applicable)
Your answer
Israeli Passport Expiration Date (If Applicable)
MM
/
DD
/
YYYY
Secondary Country of Citizenship, other than Israel (if applicable)
Your answer
Name as it appears on your Secondary Passport, other than Israel (if applicable)
Your answer
Secondary Passport Number, other than Israel (if applicable)
Your answer
Expiration Date of Secondary Passport, other than Israel (if applicable)
MM
/
DD
/
YYYY
HEALTH INSURANCE
Health Insurance Company Name *
Your answer
ID Number *
Your answer
Group Number (If Applicable)
Your answer
MEDICAL INFORMATION
Please be honest in completing this information, as it may be important in the event we need to seek medical attention for you. The following information will be held in strict confidence: however, it will enable trip organizers to plan activities on a daily basis and to respond appropriately in case of a medical emergency. International March of the Living, Inc, hereby confirms that it will maintain all appropriate confidentiality with regard to the personal and private medical information and records provided to the International March of the Living.
If you are taking any medications now, list them below with (a) Dosage in MG, (b) Prescribing Physician, and (c) Condition the medication is treating. If you are not taking any medication, please indicate none. Example: Claritin 10mg 2x/day/Dr. Smith/Allergies *
Your answer
Please indicate any of the medical conditions listed below which apply to your medical history *
Required
If you checked any of the above, please give details including name(s), date(s) and physicians or hospitals. If you checked none of the above, please list all contact information of your personal physician for emergency purposes:
Your answer
List any allergies. Include drug, food and environmental, including insects. If none, please indicate so *
Your answer
Do you wear: *
Required
Do you carry an epi-pen? *
Indicate any hospitalizations in the last 2 years and indicate the reason and dates. If none, please indicate so *
Your answer
The March of the Living is a very emotional experience. If you have had a significant death or other traumatic loss in the last 2 years that you feel we should know about, please describe it below:
Your answer
I certify that I am able to fully participate in the March of the Living program, understanding the trip may be strenuous and that I will undergo different sleep and eating patterns based on time-zone changes, frequent bus travel, possible numerous consecutive hours on my feet and walking and may experience psychologically difficult moments. By placing your name below, you confirm that you understand the physical and mental challenges of the experiences in visiting death camps and other sites in Poland and state that you accept responsibility for your own conduct and confirm your ability to participate in the March of the Living and that you are in agreement with this statement. *
Your answer
DIETARY PREFERENCE
Due to the massive scale of the March of the Living program, please note that, unfortunately, it is not always possible to meet special dietary needs. Participants with restricted diets are encouraged to pack appropriate, non-perishable food. However, if you have dietary restrictions that you would like us to know about please list them here:
Your answer
EMERGENCY CONTACTS
Primary Emergency Contact Full Name (Cannot be someone traveling on the trip with you) *
Your answer
Primary Emergency Contact Relationship *
Primary Emergency Contact Cell Number *
Your answer
Primary Emergency Contact Home Phone *
Your answer
Primary Emergency Contact Email *
Your answer
Secondary Emergency Contact Full Name (Cannot be someone traveling on the trip with you) *
Your answer
Secondary Emergency Contact Relationship *
Secondary Emergency Contact Cell Number *
Your answer
Secondary Emergency Contact Home Phone *
Your answer
Secondary Emergency Contact Email *
Your answer
APPLICANT AGREEMENT & UNDERSTANDING
1. The undersigned intends to participate in the March of The Living (“The March”) with Sinai Temple ("Sinai"). In connection with his or her participation, the undersigned hereby agrees to abide by the rules and regulations of The March.

2. The undersigned is providing medical information to the leadership of The March and Sinai on the forms enclosed with this Applicant Statement. The undersigned represents that all of the information contained in such forms is true and correct. The undersigned has read the Medical Form and agrees to abide by the conditions contained therein. All medications taken by the undersigned are detailed on the medical form or in any letters accompanying the medical form. The undersigned hereby authorizes the leadership of The March to obtain treatment for him or her as it, in its sole and absolute discretion, deems necessary and advisable. The costs of any medical treatment provided shall be the responsibility of the undersigned.

3. The undersigned agrees to hold The March and Sinai (as well as any other organizations participating in any activities relating to The March) and the leadership of these organizations, harmless from any claim, loss, damage, injury, liability or expense (including attorney’s fees) which the undersigned might sustain or incur in connection with, as a result of, or by reason of their participation in The March or any of the activities relating thereto. The organizations sponsoring The March operate the tour offered under this program only as agents of the airline, bus operators and others which provide the actual arrangements, and are not liable for any act, omission, delay, injury, loss, damage, or nonperformance occurring in connection with these arrangements.

4. The undersigned also understands that he/she is expected to participate in all orientation and pre-March courses that will take place in his/her community.

5. Please note that all food provided by The March is Kosher. However, there may be occasions as part of the program where participants will be have the opportunity to eat dairy and fish options in local Polish restaurants.

SINAI TEMPLE TERMS
Each participant in this Adult March of the Living tour is participating in a group trip to Poland and Israel (optional) in connection with the March of the Living Program. International March of the Living, Inc., a 501(c)(3) nonprofit public charity (“iMOTL”) is serving as Tour operator. Sinai Temple Sisterhood is collecting the funds and paying iMOTL for each tour participant. Sinai Temple Sisterhood is also collecting some additional funds which will be used for special add-ons to our program. By accepting the terms and the undertakings of the Parties described herein, you agree to indemnify and hold harmless iMOTL, Sinai Temple Sisterhood and Sinai Temple from and against any actions, suits, proceedings, claims, demands, judgments, liabilities, losses, damages or expenses (including court costs and reasonable attorneys’ fees) which (a) are caused by or arise out of any breach or default in the performance by iMOTL, including any deemed agents of same, or (b) any and all actions, suits, proceedings, claims, demands, judgments, costs and expenses (including reasonable legal and accounting fees) incident to any of the foregoing.

Minimum number of participants
A minimum of 35 participants is required for this departure. In the event the required number has not been reached, the tour can be cancelled. Should this occur, all deposits/payments will be refunded in full and no charges will be made to any person that had signed up for the tour.

Changes & special requests
If you need to make changes to your travel plans, we need to know as soon as possible. A service fee of $100 per person will be charged for any change made after December 1, 2018. Additional fees may apply and are to be paid by the participant requesting the extra services or changes. All special requests must be mentioned on the registration form.

Travel Protection Plan
We highly recommend that you purchase trip cancellation and travel insurance.

Passport
Each participant must possess a U.S. or Canadian Passport that must be valid until at least November 09, 2019.
Visa

No visa is required for this tour.

Disclaimer
iMOTL and/or its representatives shall act only as independent contractors for various and independent suppliers of services in connection with its tours in making arrangements for accommodation, transport, meals, or any other service, and does not assume any liability whatsoever for any injury, inconvenience, expense, damage or loss of property, death, cancellation, change in itinerary, accident, irregularity or delay due to an act of negligence of, or default of, any hotel, carrier, restaurant, company or person rendering any of the services included in the tour, or by an act of God. Further, the iMOTL is not responsible for any damage or delay due to sickness, pilferage, labor disputes, machinery breakdown, quarantine, government restraints, weather or any other causes. No responsibility shall be incurred for any additional expense, omissions, delays, re-routing or other acts of any government or other authority. The airline, steamship and railroad companies concerned are not responsible for any act, omission, or event, during the time passengers are not on board their planes or conveyances. The passenger contract issued by the airlines, steamship and railroad companies, when issued, shall constitute the sole contract between such companies, and the purchaser of these tours and/or passengers. All baggage is at the owner’s risk throughout the tours, and the iMOTL is not responsible for loss, theft or damage to baggage. The right is reserved to withdraw any tour listed herein, and/or to make such changes in the tour as may be found desirable for the convenience, comfort and/or welfare of the parties and the proper carrying out of the tour, without any penalty to the iMOTL. Additional expenses, if any, will be borne by the passenger. In certain circumstances, it may be necessary to revise the routing of the itinerary. If due to such circumstances a change becomes necessary in the sole opinion of the iMOTL, hotels substituted shall be of the same quality as those listed in the itinerary. The iMOTL assumes no financial liability for any resulting losses, expenses, or inconvenience. No refunds will be made for portions of transport, tours, rooms, or meals, and no credit can be allowed for unused accommodation. The full tour cost will be refunded, however, if the entire tour is cancelled by the iMOTL prior to the published departure date. Unless otherwise noted, all prices are per person, based on two persons sharing a cabin or hotel room. Prices are based on rates in effect (including foreign exchange rates) at the time of printing and are thus subject to increase or decrease without notice. The iMOTL is not responsible for any typographical errors and/or other inadvertent written errors.

By placing my name below, I acknowledge, confirm, accept and agree to be bound by the above agreement and understanding: *
Your answer
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