Please fill in the requested information and click the Submit button at the bottom of the page.

1. Contact Information
Full name: Required
Email address: Required
Home address:
City, state, zip:
Home telephone:
Home fax:
Business Name:
Business address:
City, state, zip:
Daytime telephone:
Business fax:
Preferred telephone, fax and mailing address:		Home		Business

2. Participant Information Tell us a bit about yourself and/or your group:
Organizational affiliation:
Synagogue affiliation:
Type of group:	Select type here Adult Student Seniors Families Other
Purpose of trip:	Select purpose here Recreational Educational Celebration Other
Number of participants:
For each participant, specify: name, age, relationship to you, date and length of previous trip to Israel:

3. Scheduling Information
Planned arrival info:
Planned departure info:
Number of days you would like to tour:
Number of days you would like to stay in:
Jerusalem:
Tel Aviv:
Galilee:
Eilat:
Other:

4. Activity Preferences
Items that are of particular interest to you on your Israel visit (archaeology, kibbutz, nature, water activities, etc.):
Sites that you particularly want to see:
Sites and items that are of no interest to you:

5. Accommodation Preferences
What types of accommodations are of interest to you?		Select type here 5-star 4-star Guest House Any Other
Are there specific hotels that are of particular interest to you? If so, what are they?
Jerusalem:
Tel Aviv:
Galilee:
Eilat:
Other:

6. The Bar/Bat Mitzvah Child
Name of Bar/Bat Mitzvah child:
Full Hebrew name:
Complete English birthday:
Complete Hebrew birthday:
Special interests:
Jewish education background:

7. The Bar/Bat Mitzvah Service/Ceremony
Day and date of service/ceremony:
Time of day of service/ceremony:	Select time here Morning Midday Afternoon Evening
Approximate number of guests:
Ceremony to be indoors/outdoors:	Select place here Indoors Outdoors Either indoors or outdoors
Venue of service/ceremony (Western Wall, Southern Wall steps, wooded grove, historic building, synagogue, hotel function room, outdoor park, other):
What kind of service/ceremony are you considering:
Would you like us to contact a local rabbi for you? If Yes, please indicate special needs or requests:
Other comments or concerns regarding the service/ceremony:

8. Catering Preferences
Day and date of meal:
Time of day of meal:	Select time here Morning Midday Afternoon Evening
Approximate number of guests:
Meal to be indoors/outdoors:	Select place here Indoors Outdoors Either indoors or outdoors
Venue of meal (wooded grove, historic building, synagogue, hotel function room, outdoor park, resteraunt, other):
Type of meal you are considering:	Select type here brunch lunch supper refreshments coffee and cake other
Type of menu:	Select type here meat dairy vegetarian fish Middle Eastern Italian other
Other comments or concerns regarding the meal:

9. Desired Service
We need you to organize the services of a stills photographer
We need you to organize the services of a video photographer
What do you have in mind in terms of music:
Other forms of entertainment:
Decorations desired (balloons, flowers, etc.):

10. Other

Special requests and needs (dietary, handicap, other):

What other concerns do you have:

Additional Comments: