Please fill out one form per family.
Travel Information
Traveler 1 - Gender Male Female
Last Name
First Name(s)
Date of Birth[MM/DD/YY]
 
Nationality
Passport Number
Date of Expiry
Doctor? yes no Name of Practice/Hospital  Specialty  
I would like to share a room with
Traveler 2 - Gender Male Female            |        Relation: 
Last Name
First Name(s)
Date of Birth[MM/DD/YY]
 
Nationality
Passport Number
Date of Expiry
Doctor? yes no Name of Practice/Hopsital  Specialty  
Additional Travelers - Number of additional travelers
Names & Relationship of additional participants
Eg. Abe Cohen - Husband, Ruth Cohen - Daughter
Passport details of additional participants
Contact Information
Address
Bus Home

City
State/Zip
 
Home Phone
Work Phone
Email
How did you hear about the trip?
Is this your first trip to Israel?
 
Payment Information
TERMS OF PAYMENT (see full description of package under the "Pricing" tab)
- The cost for the trip comes to $4,950 per person (double occupancy).  
 - Single supplement (to stay in your own room) additional $1750
- All prices and payments are in Canadian Dollars
- Deposit of $500 per participant to confirm reservations for land package
- Final and full payment is required by January 15, 2018
I will be paying my deposit Paying in full (double occupancy) Paying in full (single occupancy)
I will be paying with Credit Card Check- Please mail to: 4054 Rue Jean-Talon O, Montreal, QC H4P 1V5
Amount
Card Type
Card Number
Expiration Date
CVV What's this?
Comments
Please quote for me cancellation insurance - click here for rates/more info
 
CANCELLATION POLICY
• More than 45 days before arrival – full refund less $500 per person
• Between 15 – 44 days before arrival - $1250 per person plus any hotel cancellation fees
• Within 14 days of arrival - full payment for the entire program will be charged.
RESPONSIBILITY & INSURANCE
Chabad of The Town will not be held responsible for any loss of personal items or damage, and therefore, we STRONGLY RECOMMEND you purchase valid travel insurance which covers, trip cancellation, all health issues and luggage loss or damage.