Application Form:
YOUR BAR/BAT MITZVAH CELEBRATION IN ISRAEL
IS VERY SPECIAL
Please select one of the dates:
JUN 21, 2010 – JUL 1, 2010
AUG 16, 2010 – AUG 26, 2010
DEC 23, 2010 – JAN 02, 2011
NAMES EXACTLY AS APPEARS IN PASSPORT, LAST & FIRST NAMES ONLY
*mandatory fields
No. of Participants#:
1
2
3
4
5
6
FAMILY NAME: [1]
*
FIRST NAME:
*
Mr.
Mrs.
Ms.
Child
DATE OF BIRTH: [1]
*
DD
/ MM
/ YYYY
FAMILY NAME: [2]
*
FIRST NAME:
*
Mr.
Mrs.
Ms.
Child
DATE OF BIRTH: [2]
*
DD
/ MM
/ YYYY
FAMILY NAME: [3]
*
FIRST NAME:
*
Mr.
Mrs.
Ms.
Child
DATE OF BIRTH: [3]
*
DD
/ MM
/ YYYY
FAMILY NAME: [4]
*
FIRST NAME:
*
Mr.
Mrs.
Ms.
Child
DATE OF BIRTH: [4]
*
DD
/ MM
/ YYYY
FAMILY NAME: [5]
*
FIRST NAME:
*
Mr.
Mrs.
Ms.
Child
DATE OF BIRTH: [5]
*
DD
/ MM
/ YYYY
FAMILY NAME: [6]
*
FIRST NAME:
*
Mr.
Mrs.
Ms.
Child
DATE OF BIRTH: [6]
*
DD
/ MM
/ YYYY
MAILING ADDRESS:
CITY:
POSTAL CODE:
TELEPHONE #
[DAYTIME]
:
*
EMAIL:
*
Number of rooms required :
(Cost for single supplement, triple room and
a family room will be provided upon request)
1
2
3
4
5
6
Remarks
BAR_BATMITZVAH_90814
