REGISTRATION Questions about this form? Please contact motorcitymission@jfmd.org. Motor City Mission trip to Israel 2023 1Getting to Know You2Traveler status3Mission Liability4Mission cost 5Traveling group request 6Review7One More Step to Completion! Name as it appears on your passport* First Middle (if applicable) Last Name as you prefer on your name tag* First and last Email* Date of birth*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Phone number*Home address* Street Address Address Line 2 City Postal Code State*StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCountry*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Are you traveling with:* Alone Spouse/ Significant Other/ Friend/ Family Member/ Companion I am traveling alone, but am interested in sharing a room with another participant. Travel partner* Spouse / Significant Other Friend / Family Member / Companion Other PLEASE NOTE: This person will be assigned as your roommate. A separate registration form must be completed for each mission registrant using a UNIQUE email address. Full name of spouse / significant other* Full name of friend / family member / companion* Full name of other* Mission Liability COVID-19 Agreement*The Jewish Federation of Metropolitan Detroit is requiring all Motor City Mission travelers be fully vaccinated against Covid-19. There will be regular updates regarding exact Covid-19 protocols. Closer to the date of departure, travelers will be asked to provide all mandatory documents and signed statements (e.g., proof of vaccination). I agree to follow all mandatory Covid-19 requirements for entry and departure at the time of the mission Cost and Subsidy information*Please choose your preferred option. I would like to opt-in to the basic Federation subsidy program and agree to pay $3,999 (land-only, per person, double occupancy) cost. I do not require the Federation subsidy and agree to pay the $4,999 (land-only, per person, double occupancy) cost. NOTE: Subsidies must be requested by August 8, and will be confirmed by August 15, 2022. Airfare not included. Air transportation arrangements must be made and booked by Mission participants on their own. Single Occupancy I am traveling alone and would like to upgrade to a single room for an additional cost of $1260 I would like to travel on the same bus with the following people (please limit to four names):Request to travel with I would like to travel on the same bus with the following synagogue /organization:Synagogue /Organization Name: *While the Federation will make every effort to accommodate these requests, they cannot be guaranteed Unique IDHiddenDeposit Amount DuePlease check your information before submitting your form: {all_fields} To officially secure your spot, please pay your refundable deposit of $500 by clicking the button below. (Note: Each mission traveler must complete their own application and pay their deposit separately. We apologize for any inconvenience this may cause.) Payment schedule: Refundable deposit of $500 is due as part of this initial registration.Paid-in-full due by December 1st, 2022. Motor City Mission payments are by credit card only. Please note that a 3% processing fee will be assessed to cover the cost of your payment. If you have any questions, or need assistance, please contact motorcitymission@jfmd.org Δ