TRIP REGISTRATION

Aish Chizuk Mission: Jan 28 – Feb 4, 2014

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Please note: the trip is currently sold out. You are welcome to fill out this form to be placed on a waiting list. Please do not make any payments until you are notified that we have a slot for you.

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Trip(Required)

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Date

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TripID

Note: If you are traveling with your spouse, fill out the form once for each person.

My Family

I am a...

Spouse

Child

(please fill out this form separately for each person who is attending the trip)

Traveling with:

I am a...

BLS Member

BLS Guest

(please fill out this form separately for each person who is attending the trip)

Member's Name

Title

Participant Information

First Name (for nametag)(Required)

Last Name (for nametag)(Required)

Email(Required)

Gender(Required)

School(Required)

Staff Member

Are you a staff member?

Grade(Required)

Note: If you are a staff member traveling with a specific grade, please choose that grade.

Passport Information

Your passport needs to be valid for at least 6 months AFTER your return date.

If you are waiting for your passport you may write "pending", and enter today's date for the expiration date. Please email your passport information to [email protected] as soon as you have it.

First + Middle Name on passport(Required)

Last Name on passport(Required)

Passport Number(Required)

Exp. Date(Required)

Country of Citizenship(Required)

Date of Birth(Required)

Are you an Israeli citizen?(Required)

If you are a dual citizen of Israel and another country please choose Yes

Full Name as you would like it to appear on your name tag

How did you hear about the program?(Required)

Which branch?(Required)

How did you hear about the program?(Required)

Name of the referring individual or organization(Required)

If you are affiliated with an Aish Branch, please indicate which one:(Required)

What do you hope to gain from the trip?(Required)

Participant Contact Information

Address(Required)

City(Required)

State/Province(Required)

Zip Code(Required)

Home Phone

Cell Phone(Required)

Work Phone

Country(Required)

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Fax

Note: We use email as the primary method of communication about the trip. Please double check that your email address is entered correctly, and check periodically for any emails sent from GoInspire. If you do not receive a confirmation email after submitting this form, please send an email to [email protected] to make sure we received your application.

WhatsApp Phone Number

Spouse's Name

Employment Information

Current Employer

Job Title

Special Requirements

Do you have any accessibility requirements or physical limitations or restrictions?

Do you have any special dietary requirements or allergies?

Are you currently receiving any medical treatment or psychological counseling?

Have you received psychological counseling in the past?

Have you been hospitalized or had surgery in the past year?

Are you currently taking any medication?

Jewish Affiliation

Is your spouse Jewish?

If you have children, how many do you have?

Please enter a number greater than or equal to 0.

Do your children attend Jewish Day School?

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Which program are you affiliated with?(Required)

Marital Status

Married

Widowed

Divorced

Single

Husband's Name

Religous Status

Are you a Neve alumna?

Yes!

Israel Experiences:

I have been to Israel before

I have gone on a JWRP trip

What was the date of your trip? Which branch did you go with?

Flights

Flight Information

GoInspire will be happy to help you book a flight. Please send an email to [email protected] with the dates you'd like to travel, and we will be in touch shortly.

Suggested Flight Information:

ELAL - JFK flights
Date	Flight	Departs	Arrives
Sunday April 30	ELAL 002	5:30 PM JFK	11:00 AM May 1 Tel Aviv
Monday May 8	ELAL 001	1:00 AM Tel Aviv	5:50 AM May 8 JFK

ELAL - JFK outbound, Newark return
Date	Flight	Departs	Arrives
Sunday April 30	ELAL 002	5:30 PM JFK	11:00 AM May 1 Tel Aviv
Monday May 8	ELAL 025	1:00 AM Tel Aviv	5:45 AM May 8 Newark

United – Newark flights
Date	Flight	Departs	Arrives
Sunday April 30	United 084	4:20 PM Newark	9:55 AM May 1 Tel Aviv
Sunday May 7	United 091	11:35 PM Tel Aviv	4:15 AM May 8 Newark

Note: The program ends Sunday night May 7th. Be sure to book your return flight no earlier than 11:30pm.

GoInspire can help you book flights if you'd like; more information will be forthcoming.

Did you book your flights yet?(Required)

GoInspire can arrange flights for you

I'd like help booking my flights

In order to provide our dedicated travel agent service both prior and during your trip, your flight cost will include a $75 booking fee.

Once you book your flights, please email the information to [email protected].

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Group Flight

I would like to join the group flight

Flight Details

Airline Meal Request

Click here to view El Al's meal options

Frequent Flyer Plan (optional)

Frequent Flyer Number

Seating Preference

We will try to honor your request, but unfortunately we cannot always get the seat you prefer.

I would like to sit near: (We will do our best to accommodate your request.)

Would you like to upgrade your seat?

If indicated on your application, we will contact you with options and pricing. You can also decide to upgrade after your ticket is booked.

Would you like to extend your trip?(Required)

Yes

First choice for ticket change. Submit a date and time preference.(Required)

Second choice for ticket change. Submit a date and time preference.(Required)

Extensions are based on pricing and availability; the earlier you submit your request, the more likely we will be able to honor it. If you decide to extend after submitting this form, send an email to [email protected].

Parents' Information

Please enter information for at least one parent.

Mother's Name

Mother's Email

Mother's Cell Phone

Father's Name

Father's Email

Father's Cell Phone

Mother's Address(Required)

Father's Address(Required)

Mother's Phone (daytime)(Required)

Father's Phone (daytime)(Required)

Other

What's your Jewish background?(Required)

Current Jewish Affiliation(Required)

Roommate Request

Single room upgrade

Single rooms are limited and will be given on a first-come first-serve basis. Single rooms will only be confirmed once payment is received. The price for a single supplement is $.

I may be interested upgrading to a single room for an additional fee (will be confirmed based on availability)

Please enter the names of two additional students with whom you would like to share a room.

The price for a single supplement is $975.

The price for a single supplement is $960. This amount is above and beyond the registration fee.

Photo of Yourself (To be placed on the itinerary)

Max. file size: 100 MB.

Please note: files with an apostrophe in their names may cause an error when trying to Submit, please rename those files before uploading.

What are your favorite Jewish / Israeli songs?

What size sweatshirt would you like to receive?

Please note the sweatshirts run small

Yarchei Kallah Trip Package Options(Required)

Which parts of the program will you be joining us for?

Your trip includes 4 nights in the hotel. If you will not be staying in the hotel for any or all of those nights, please indicate so in the Comments below.

Emergency Contact (Name and Phone Number)(Required)

Comments / Special Requests

Please provide us with an emergency contact located in Israel. Enter their name, address, daytime telephone number, and their relationship to the participant.

Optional add-ons

Addons

Please indicate if you may be interested in booking the trip add-on.

2 extra nights before the trip ($550)

Includes the cost of the tasting tour at Carmel Market on Friday

Travel Details

Pease enter the information here.

Country of Departure(Required)

Flight to Tel Aviv:

Flight from Tel Aviv:

Departing Flight Airline(Required)

Return Flight Airline(Required)

Departing Flight Airline (if you chose other)(Required)

Return Flight Airline (if you chose other)(Required)

Departure Airport(Required)

Enter the departure airport for your flight which will arrive at TLV.

Return Airport(Required)

Enter the return airport for your flight which will depart from TLV.

Departing Flight Number(Required)

Flight numbers should be 3 or 4 digits. If your flight number is less than 3 digits, please add zeroes at the beginning.

Return Flight Number(Required)

Flight numbers should be 3 or 4 digits. If your flight number is less than 3 digits, please add zeroes at the beginning.

Departing Flight Date(Required)

Time of Departure(Required)

Return Flight Date(Required)

Time of Departure from Israel(Required)

Date of Arrival in Israel(Required)

Time of Arrival in Israel(Required)

Date of Arrival(Required)

Time of Arrival(Required)

Vaccine and Documents

Please note: files with an apostrophe in their names may cause an error when trying to Submit, please rename those files before uploading.

Proof of Vaccination

Max. file size: 100 MB.

Copy of Passport

Max. file size: 100 MB.

Vaccine

Vaccine Date - First Dose

Vaccine Date - Second Dose

Vaccine Date - Booster

Type of Vaccine

Participant Waiver

Please note: No alcohol consumption will be allowed for the duration of this trip.(Required)

Please enter your initials in the box below

You must agree to the waiver in order to continue(Required)

Click to view the GoInspire Participant Waiver

I have read the waiver and agree to the terms.

WAR ADDENDUM(Required)

GoInspire requires payment to reserve a spot on this tour. Please note that GoInspire reserves the right to cancel the trip in the event of the closing of the Tel Aviv airport or any other contingency resulting from the fallout of the events of October 7, or if in our sole judgment it is no longer advisable to move forward with this trip. If we cancel your trip we will issue refunds based on the trip payment terms.

GoInspire shall not be liable or responsible for any personal injury or property damage that befalls you by reason of any delay, modification, or interruption pertaining to this tour or your participation in this tour. You hereby release, covenant not to sue, discharge, indemnify, and hold harmless GoInspire, its members, staff, employees, volunteers, agents, and representatives of and from any Claims of any kind or relating to the war brought about by the events of October 7. This release, covenant not to sue, discharge, and indemnification includes any Claims based on the actions, omissions, or negligence of GoInspire, fellow participants, and everyone else associated with this trip, including third parties not associated with the trip.

If you decide not to come on the trip for whatever reason, be it for safety reasons or another reason, we will refund all but $950 of the amount you have paid.

As we mentioned in our basic terms and conditions, GoInspire will secure tourist medical insurance to cover you while in Israel. Please note that this insurance will not cover pre-existing conditions or injuries resulting from war or military conflict.

I have read the war addendum waiver and agree to the terms.

WAR ADDENDUM(Required)

I have read the war addendum waiver and agree to the terms.

You must agree to the waiver in order to continue(Required)

Click to view the GoInspire Student Participant Waiver
Click here to:

View your tourist health insurance coverage details
Extend your health insurance for additional days before or after the trip
Apply for coverage for pre-existing conditions and for participants over age 75

I have read the waiver and agree to the terms.

In addition to agreeing to the waiver and submitting this registration form, there are three forms which need to be printed, filled out, and returned to us.

Click to view and print the CIJE Participant Rules

Click to view and print the Medical Form

Click to view and print the GoInspire/CIJE Participant Waiver

All forms should be scanned and emailed to [email protected], or mailed to:
GoInspire
28 Park Avenue
Airmont, NY 10952

No participant will be allowed to join the trip without sending in all 3 forms.

Click Submit to continue the registration process.

Payment Terms

The trip price is $2,050, with an early bird special of $1,850 for participants who register before December 2nd.
$500 non-refundable deposit due with application.
$800 due December 2nd. $250 of this is non-refundable
Remaining balance due March 1st. This payment is non-refundable
All costs are non-refundable as of March 1st.
Program payment does not include gratuities. Please bring $75 USD per person to Israel for tips.
All cancellations must be made in writing.
All prices listed are in USD.

Aish Minnesota Participant Waiver(Required)

Click to view the Aish Minnesota Participant Waiver

I have read the Aish Minnesota’s Participant Requirements and Waiver and agree to the terms therein.

Poland Trip Participant Waiver(Required)

Click to view the Participant Waiver

I have read the Waiver and agree to the terms therein.

Chizuk Participant Waiver(Required)

Click to view the Participant Waiver
Click here to:

View your tourist health insurance coverage details
Extend your health insurance for additional days before or after the trip
Apply for coverage for pre-existing conditions and for participants over age 75

I have read the Waiver and agree to the terms.

Participant Waiver

Acceptance will be determined after an interview; once your application is reviewed, you will be contacted by your local sponsoring organization.

Acceptance is determined after an interview. You will be contacted shortly for a brief phone interview.

Health Insurance(Required)

Your trip includes health insurance coverage for the trip dates listed above.
Click here to:

View your tourist health insurance coverage details
Extend your health insurance for additional days before or after the trip
Apply for coverage for pre-existing conditions and for participants over age 75

I understand what health coverage I will receive and will take any steps necessary to ensure I am covered for the duration of my stay in Israel.

LAST STEP: The final step in the application process is to click Submit and follow the instructions to pay the $500 deposit.

Payment

Deposit

Price:

A deposit is required in order to submit your application. This deposit is non-refundable upon acceptance and will be applied towards your trip balance.

In order to reserve a spot on this trip, payment is due with registration.

Please choose your payment option:(Required)

$500 (deposit)

Other Amount (please explain)

Join the trip for a day(Required)

Price:

Please enter the number of days you would like to join (between 1 and 4):(Required)

Please enter a number from 1 to 4.

Which days?

Monday

Tuesday

Wednesday

Thursday

$3,800 price includes 3 nights at the David Citadel hotel (double occupancy), all programming, speakers and guides, security guard as needed, ground transportation, health insurance, and 2-3 meals per day.
5% processing fee will be added.
Tips (approx $100 USD pp) are not included in the costs. Please bring this with you to Israel.
Sponsorships for soldiers not included. To sponsor dinners with soldiers with charitable donation receipt: https://secure.cardknox.com/jerusalemfellowships?XCustom02=Israel+Relief+Fund&XDescription=Yonina+Trip
Dedicated department to help with purchasing airline tickets, travel insurance, additional hotel nights, and single occupancy upgrades.

Please choose your payment option:(Required)

Amounts listed include the 5% processing fee

$3,990 (full trip price)

$4,565 (full trip plus single supplement)

Other Amount (please explain)

Please choose your payment option:(Required)

$2,825 (full trip price)

Other Amount (please explain)

Payment Amount(Required)

Payment Notes(Required)

Please choose an option:(Required)

Trip with Hotel ($2,450)

Trip without Hotel ($1,800)

How would you like to pay?(Required)

I would like to pay online via Credit Card

I would like to mail a check to the shul

Checks can be mailed to Congregation Brothers of Israel
250 Park Ave
Long Branch, NJ, 07740

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Payment Amount

Total

Please note: in order to be eligible for the Early Bird Special, you must make all trip payments by the due dates. The payment schedule is included in the acceptance email.

Upon clicking Submit you will be redirected to our secure payment site to pay for your trip. Note: credit card payments will include a 2.5% processing fee; to avoid that fee you can mail a check to:
GoInspire
28 Park Avenue
Airmont, NY 10952

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