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Registration Form | Dr. Andres J. Peralta
YES - I am interested in joining the European Mission Tour!
Led By: Atlantic Union Adventist Youth Ministries (Dr. Andres J. Peralta)
July 22 - August 5, 2018
Costs for Air & Land + Tax:
$3,899 Per Person sharing a Double Room
$495 Supplement for a Single Room
Payment Schedule:
- A Deposit of $250 per person is required to Guarantee Your Space
- Final Payment is due by: May 29, 2018
* Please submit this form online only; please do not print.
Title
Pastor
Doctor
Mr.
Mrs.
Ms.
I will be returning on:
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July 31, 2018 from Berlin
August 5, 2018 from Frankfurt
Last Name
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First Name
*
Middle Name
Gender
*
Male
Female
Passport Number
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Date of Issue
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DD
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YYYY
Date of Expiration
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MM
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DD
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YYYY
Country of Citizenship
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Date of Birth
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Travel Insurance (booked directly with the Atlantic Union Youth Department)
Yes
No
Meal Request on Flight
Regular
Vegetarian
Kosher
Additional Family Member Traveling with you:
Last Name
First Name
Middle Name
Gender
Male
Female
Passport Number
Date of Issue
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DD
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YYYY
Date of Expiration
MM
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DD
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YYYY
Country of Citizenship
Date of Birth
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Travel Insurance (booked directly with the Atlantic Union Youth Department)
Yes
No
Meal Request on Flight
Regular
Vegetarian
Kosher
Mailing Address
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Please make sure to include your apartment number to guarantee delivery of travel documents.
Phone
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Email
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Room Type
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Single Room (for 1 person only = +$495)
Double Room (for 2 people only = 1 double bed)
Twin Room (for 2 people only = 2 twin beds)
Triple Room (for 3 people only = 2 twin beds + sofa bed/cot)
If you chose a Double, Twin, or Triple room, please list your roommate(s) name(s) below:
Questions or Comments:
Please Note:
1. Current airport taxes are subject to change by the airline prior to ticketing
2. Price is based on a minimum of 25 participants
3. Please submit a copy of your passport, which must be valid for at least 6 months from the date of departure
4. To complete your registration, a deposit of $250 per person is required
Mailing address for $250 deposit + passport copy:
Go Israel NA
200 Winston Drive #1702
Cliffside Park, NJ 07010
5. To pay your deposit by credit card, please visit our secure website:
www.GoIsraelNA.com/payment.htm
* Please note: for international credit cards there is a 4.5% processing fee
6. By signing this form you agree to our Terms & Conditions:
www.GoIsraelNA.com/terms.htm
Signature:
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Today's Date
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