Israel Amplified, August 6-8, 2012, Phoenix
Thank you for your interest in attending the 2012 Israel Amplified conference at the Arizona Biltmore Hotel. The Alpha Epsilon Pi Fraternity, in partnership with The David Project, Israel on Campus Coalition, Charles and Lynn Schusterman Family Foundation, Jewish National Fund, and Hasbara Fellowships, is proud to bring you the ONLY conference of its kind. Israel Amplified is a three day summit at which 150 student leaders from a variety of fraternities, sororities, and backgrounds will explore how to effectively bring a conversation about Israel activism into the collegiate Greek system.

Please take a few moments to fill out the following application. All applications will be reviewed and notices of acceptance will be sent out in early May.

**THERE ARE STILL SPACES AVAILABLE TO PARTICIPATE. APPLY TODAY!**

Contact Information
First Name *
Your answer
Last Name *
Your answer
University/College *
Your answer
Expected Graduation Month/Year *
Your answer
Fraternity or Sorority Affiliation *
Your answer
Email Address *
Your answer
Phone *
Your answer
Alternate Phone *
Your answer
Permanent Address: Line 1 *
Your answer
Permanent Address: Line 2
Your answer
Permanent Address: City, State, Zip *
Your answer
Alternative Address: Line 1
Your answer
Alternative Address: Line 2
Your answer
Alternative Address: City, State, Zip
Your answer
Date of Birth *
Your answer
Sex
Application Questions
How are you involved on your campus and what leadership positions do you hold? *
Your answer
In what ways has your fraternity or sorority experience positively impacted your life? *
Your answer
Have you ever been to Israel? If so, please tell us about your experience(s).
Your answer
What does Israel mean to you or why do you see Israel as something you’d like to learn more about? *
Your answer
How do you see the Greek community being an asset to Israel activism on campus? *
Your answer
What skills and knowledge do you hope to gain from your experience at Israel Amplified? *
Your answer
Do you have any additional comments you would like to share?
Your answer
Do you have any special dietary (vegetarian, kosher, etc.) or other needs that you want us to know about?
Your answer
Registration Infrormation
Israel Amplified will be held at the Arizona Biltmore Hotel from August 6-8, 2012.

Registration payment:
If accepted to the program there will be a $70.00 registration fee which will cover meals, room and board, and travel up to a designated amount based on from where you are traveling to Phoenix. Once you are accepted to the program you will be asked to pay the $70.00 fee in order to confirm your participation in the conference.


Travel information:
You are responsible for booking your own travel. However, at the conclusion of Israel Amplified, you will be given a travel subsidy reimbursement based upon your city of origin. Subsidies will range from $175-$400.

You must submit your travel itinerary receipt to Adam Teitelbaum no later than July 20, 2012 in order to receive your reimbursement check at the conference.

If you have any questions please contact:
Adam Teitelbaum, Howard Lorber Director of Jewish and Philanthropy Programming for AEPi, ateitelbaum@aepi.org, or 317-876-1913; or
Phillip Brodsky, Campus Team Manager at The David Project, pb@davidproject.org, 617-428-0012

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