Let's Go: Israel 2012 - Application Form

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Join fellow Bay Area teens for the most amazing Israel experience. The Let’s Go: Israel (LGI) Experience is a four-week Bay Area based Israel program sponsored by the Jewish Federation of the East Bay and run by the Center for Jewish Living and Learning. As a participant of LGI you should be prepared to challenge yourself, be immersed in Israeli culture, make new life-long friends, and make Israel part of your life forever. Graduates of the program are expected to share the summer experience in their own unique way with their community (i.e. peers, synagogue, school, youth group) upon returning home to the Bay Area.

Travel dates: June 19th to July 18th
LGI Price: $7,350
Early Bird Price: $6,990- Ends at 5:00pm on Monday, January 16, 2012

Pre-Trip Retreat: Friday, May 18 - Sunday, May 20, 2012
Two additional Group Meetings before the trip will be required.

IMPORTANT:

The application deadline is March 2, 2011. Applications received after March 2, 2011, will be accepted on a space available basis.
To ensure your place, the $150 non-refundable deposit must be received by the registrar.

Please make your check out to:
Jewish Federation of the East Bay
Place “Let’s Go: Israel” in the memo section

Please mail your check to the following address:
Loal Isaacs- Let’s Go: Israel 2012
Jewish Federation of the East Bay
300 Grand Avenue, Oakland CA, 94610-4826

After your application and registration fee are received, you will receive a package containing program information, medical forms and financial aid information (if needed) will be sent to you.

Cancellation
If for any reason you choose not to participate in the program please notify Loal Isaacs immediately. Cancellations for documented healthy reasons (Doctor’s note required) will receive a full refund (less the registration fee). After March 2, 2011, no refunds will be available.

I have read, understand and agree to the above information, and I understand that a $150 Application Fee is due to complete the applicaiton process *

YES

PERSONAL

Participant First Name *

As it appears on your passport

Participants Middle Name *

As it appears on your passport

Participants Last Name *

As it appears on your passport

How would you like to be called?

Nick name

Date of Birth *

(mm/dd/yy)

Gender *

MALE

FEMALE

Street Address *

Location where all trip information should be sent

City *

State *

Zip *

Region *

Participants Home Phone *

Participants Cell Phone *

Participant E-mail Address *

Participant T-shirt Size *

The offical LGI shirt is only availalbe in ADULT sizes

What high school does the participant attend? *

Grade in school *

Synagogue *

Please list the synagogue of which your family are members. If you are not members, place N/A in the box below.

I participate in one of the follow Jewish programs *

Midrasha- Berkeley

Midrasha- Contra Costa

Midrasha- Oakland

Midrasha- TVTC

Noar Nights- Temple Isaiah

Other:

Required

I am active in non-Jewish organizations *

YES

If YES, please describe

I have friends who plan on attending Let's Go: Israel? *

YES

If YES, please add their names below

How did you hear about the Let's Go: Israel experience? *

Is your teen Shomer Shabbat? *

YES

Other:

PASSPORT INFORMATION

I have a US Passport valid for SIX MONTHS after my return from Let's Go: Israel 2012 *

(End of January 2013)

YES

Full Name *

as appears on the Passport

Passport Number

Expiration Date *

Date Issued *

Place Issued *

Place of Birth *

Nationality *

Must list here if you are a citizen of a country other than USA

I am Israeli *

If YES, you will receive additional instructions in order to travel to Israel

YES

Contact Information

Parent/Guardian Name #1 *

Primary Emergency and Contact Person

Relationship *

Cell Phone *

Home Phone *

Work Phone

E-mail *

Street Address *

City *

State *

Zip *

Parent/Guardian Name #2 *

Secondary Emergency and Contact Person

Relationship *

Cell Phone *

Home Phone *

Work Phone

E-mail *

Street Address *

City *

State *

Zip *

Do you have friends or a relatives in Israel? *

YES

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