To Register, please print and mail with your deposit(s) to the address below
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Keep a copy for your records (Copy for additional passengers) Tour Code
SRC0511
Registration Form
Journey to Israel May 3 - 12, 2011
PLEASE PRINT
One registration form per person
Name (as appears on passport) : _________________________________________________________________
Name for name tag : ____________________________________________________________________________
Physical Address :______________________________________________________________________________
City : _____________________________________ State :_____________ Zip : _______________
Day phone : (______)________-__________________ Evening phone : (______) _______-__________________
Email : _______________________________________________________________________________________
Passport # : ________________________________________________________Expires :____________________
Issue place : _____________________ U.S. Citizen: Yes:_____ No: _____ Date of Birth:_____/_____/__________
Tour Roommate : ______________________________________ Requested single room ______ (additional $450.00)
Emergency Contact:
Name :____________________________ (________) _______-_________________ Relationship : ________________
( Tour Price : is a Cash / Check Discount price)
Tour Price : $2,775.00 (plus airline taxes and fuel surcharge*)
(per person based on double occupancy)
Payment schedule :
To reserve a seat, a Deposit of $ 500.00** on or before: Nov. 7, 2010
2nd payment of $1,500.00 must be received on or before : Jan. 7, 2011
Final Balance plus taxes & fuel surcharges due on or before : Mar. 7, 2011
Tour price is valid for the first 22 registrations. Space is limited, register now!
Space will be reserved as registrations and deposits are received.
(Full itinerary and complete terms and conditions shall be included in color brochure)
___ I desire a single room accommodations (additional $450.00)
Registration Deposit enclosed $ _________________________ ($ 500.00 per person)
( **cancellation & refund penalties shall apply)
Signature : ________________________________________ Date : _______/_______/____________
(complete terms and conditions shall be included in color brochure)
Mail your completed form with deposit check (or payment in full) to:
Shama Resource Center, Inc. P.O. Box 81084 Bakersfield, CA 93380 U.S.A.
Make all checks payable to: SRC
(*Airline taxes and fuel surcharges are not included, but will be included at final invoicing.
Should the airlines impose an increase in taxes or fees, the difference will be collected before travel.)
Shama Resource Center, Inc. A Non-profit Public Benefit Corporation
© 2006 - 2011 Copyright Shama Resource Center, Inc. All rights reserved.