THE J² REGISTRATION FORM.
PLEASE COMPLETE THIS FORM FOR EACH TRAVELER. A J²REPRESENTATIVE WILL BE IN TOUCH TO SHARE MORE INFORMATION AND COLLECT MORE DETAILS CLOSER TO THE TRAVEL DATE.

TRIP NAME

Temple Shalom of Newton Food, Wine and Politics of Israel, Led by Rabbis Rabbi Allison Berry and Laura Abrasley

CONTACT DETAILS

SURNAME

FIRST NAME

MIDDLE

PRONOUNS

(Optional) What are your pronouns? (e.g. she/her, he/him, they/them, use my name) For information

about pronouns, please see: https://urj.org/quick-guide-pronouns

PLEASE ADD YOUR ROOM PREFERENCE: SINGLE, DOUBLE, TWIN, CONNECTING, ADJOINING, AND ADD NAMES OF OTHER(S) SHARING YOUR ROOM.

PASSPORT INFORMATION

DATE OF BIRTH.

PASSPORT NUMBER

EXPIRATION DATE.

CITIZENSHIP

FULL CONTACT INFORMATION

HOME ADDRESS

EMAIL

MOBILE

HOME TELEPHONE #

COVID VACCINATION DETAILS

HOW MANY VACCINATIONS WILL YOU HAVE HAD BY THE START DATE OF YOUR TRIP?

DATE OF LAST VACCINATION

VACCINATION (i.e Pfizer, Moderna, Johnson & Johnson etc.)