Mosaic of Peace 2021 Conference in Israel/Palestine: Witnessing for Peace and Wholeness in a Land Called Holy
April 5-16, 2021

CONFERENCE PARTICIPATION APPLICATION FORM
Applications will be accepted through December 1, 2020. After that time applications will be considered as space is available. Contact the Peacemaking Program for information.

Please complete one form per person and return to the Presbyterian Peacemaking Program AS SOON AS POSSIBLE. We will send a confirmation of your form’s successful submission. Notification and commitment packets will be sent shortly after your application is received and processed. First-time visitors to the Holy Land are encouraged to attend. Previous conference participants and seasoned travelers to the region are welcome as well. Must be 18 years old.

Email address *
PERSONAL INFORMATION
First Name *
Last Name *
Preferred Phone *
Is your preferred phone: *
Alternate Phone
Is your alternate phone:
Mailing Address *
City *
State *
Zip Code *
Date of Birth (mm/dd/yyyy) *
Gender *
CHURCH AFFILIATION
Denomination *
Church Name *
Church Mailing Address *
Presbytery/Judicatory *
What best describes your relationship to the church? Please check all that apply. *
Required
Are you a recent seminary graduate? If so, please include the name of your seminary and year of graduation, if applicable.
NARRATIVE QUESTIONS
Where applicable, please limit your responses to 150 words or less.
Have you ever lived in or visited countries outside the United States? If so, briefly describe your experience, including the countries and dates. *
Have you ever traveled to Israel/Palestine? If so, what motivates you to return? If not, what most captivates you about this conference? *
Tell us about your experience with peacemaking and your work for peace and justice in your congregation, community, mid-council, or within the larger church. *
In what ways do you hope to be inspired, equipped, and connected by taking part in this conference? *
What unique gifts and strengths would you bring to the conference? Do you have music, art, writing, social media, photography, worship leadership or other gifts that you would be willing to share? Please explain. *
How would you imagine you would return to share your experience and "to take meaningful action for a just and lasting peace in the region?” *
What else would you like to share that can help us get to know you? *
CONFERENCE PREPARATIONS AND ARRANGEMENTS
The conference includes pre-conference webinars and assigned readings. Are you willing to commit to these? *
The conference involves a moderate level of physical activity, provides a nice variety of regional cuisine and includes simple but comfortable hotel accommodations. Do you have special accommodations or concerns of which we should be aware? *
If yes, please explain:
SESSION OR PRESBYTERY/JUDICATORY ENDORSEMENT
Conference participants are expected to have a relationship with a church community, to have the support of the community for the trip, and to share their learning with the community when they return. Please include below the name and contact information of a person who can endorse your participation. We will email that person an endorsement form for their response.
Name of Endorser *
In what capacity will this person submit their letter of endorsement? *
E-mail address *
Phone *
A copy of your responses will be emailed to the address you provided.
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