PARTICIPANT 2 (exactly as on passport) Passport #*: Date of Issue: Home/Office #: Date of Expiration: Nationality**: Mobile #:

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1 Please complete this form and send to: Elena Zamudio, the FIDF Mission Liaison, from Mosaic Tours 6345 Collins Ave Miami Beach, Fl or tours.com or Fax: (305) or Tel:(305) Note the entire cost of the mission is not-deductibe. PLEASE SUBMIT A COPY OF THE PHOTO PAGE OF YOUR PASSPORT WITH THIS APPLICATION PARTICIPANT 1 (exactly as on passport) Name: (Title/First/Middle/Last) Date of Birth: Name as you would like it to appear on name tag: Place of Birth: Address: (Street/City/State/Zip) Passport #*: Date of Issue: Home/Office #: Date of Expiration: Nationality**: Mobile #: Emergency Contact (Name/Relationship/Phone#) Shirt Size:(S/M/L) PARTICIPANT 2 (exactly as on passport) Relationship to above participant Name: (Title/First/Middle/Last) Name as you would like it to appear on name tag: Date of Birth: Place of Birth: Address: (Street/City/State/Zip) Passport #*: Date of Expiration: Date of Issue: Nationality**: Home/Office #: Mobile #: Emergency Contact (Name/Relationship/Phone#) Shirt Size:(S/M/L) *Please be advised that your passport must be valid for at least 6 months after your return flight to the U.S. ** Holders of Israeli passports are subject to VAT on accommodation. Israeli law requires Israeli passport holders to enter Israel only on their Israeli passport even if dual citizenship. 1

2 LAND ONLY $4,500 per-person based on double occupancy $5,495 single occupancy supplement If you are interested in any deviations from the basic mission package, including flights, or hotel upgrades, please contact Elena Zamudio, the FIDF Mission Liaison, from Mosaic Tours tours.com or Tel:(305) Based on Double Occupancy $4,500 per-person x $ Based on Single Occupancy $5,495 per person x $ Total: $ Please provide us with your flight information: (meeting point is at the King David hotel, Jerusalem) Arrival Date* Airline Flight Departure City Arrival Time Class *Please indicate the date of arrival in Israel, and not the date of departure from the U.S. Since transportation to and from the airport is not included in the package if you want to reserve VIP service and transportation please contact our travel agent who will process the request and advise you costs. Departure Date Airline Flight Arrival City Departure Time Class Accommodation Upgrades: Upgrades are available for an additional fee. Please note upgrades must be paid at time of booking in order to confirm. Room upgrades are non refundable and are above and beyond the cancellation policy. 2

3 Participant 1 bio: Participant 2 bio: How did you learn about the Mission? My local chapter FIDF Website/ Other Friends of the Israel Defense forces is a 501 (c)(3) not-for-profit organization.

4 Please note, deviation can't be paid with American Express. PAYMENT* Final payment due by Feb 1, 2018 Deposit (due with application) $1,000 per person x $ Total Name: (as it appears on card): VISA AMEX MC Card #: Exp. Signature: Check enclosed (please make checks out to Friends of the IDF) FEE DOES NOT INCLUDE: Transportation from/to the airport, airfare transportation between point of origin and airport of departure; airport taxes; customs and immigration fees; passports & visa fees; travel and baggage insurance; meals not included in table d hotel menus; after meal beverages; personal expenses (i.e. alcoholic drinks during meals, laundry, mini bar, valet services, cables, phone calls, postages, etc.). Health, travel and baggage insurance are the responsibility of each participant, and are not included in the Mission costs. CANCELLATION POLICY: Cancellations up to January 1, 2018 incur a $1,200 cancellation fee, per participant. Cancellations between January 1 February 15, 2018 incur a $2,000 cancellation fee, per participant. Cancellations after February 15, 2018 incur a 100% cancellation fee, per participant. Mission cancellation insurance is available at an additional charge and is recommended. There will be no refunds for unused Mission components or services. *NOTE: ALL CANCELLATION FEES ARE NON REFUNDABLE. ALL CANCELLATION FEES WILL GO TOWARDS PAYING FIDF s COMMITMENTS TIED TO THE MISSION. ANY BALANCE OWED TO YOU BEYOND THE CANCELLATION FEE WILL BE REFUNDED TO YOU PER THE CANCELLATION SCHEDULE ABOVE. Itinerary is subject to change based on IDF activities and availability of locations and presenters/hosts. The above prices include only those accommodations and activities that are listed in the itinerary. 4

5 5 Additional terms conditions and waivers General: The arrangements for the mission for which you are registering ( Mission ), including air and ground transportation, hotel accommodations, restaurants, tours and other features of the Mission, have been made by Mosaic Tours ( Agent ) as agent for Friends of the IDF ( Sponsor ) which is the sponsor of the Mission. Agent will exercise reasonable care in making these arrangements, but neither the Agent nor the Sponsor will assume or bear any responsibility or liability for any personal injury, sickness, death, loss or damage to property occurring during the Mission or due to any other circumstance whatsoever beyond Agent s control, or due to the act or omission of any airline, hotel, restaurant or other party supplying goods or services included in the Mission. Agent and Sponsor reserve the right to cancel or change the itinerary for the Mission or to substitute features of the Mission without notice when reasonably required by the circumstances, and to decline to allow or to continue participation in the Mission by any person whose health, medical condition or general deportment may impede the operation of the Mission or detrimentally affect the other Mission participants. Medical Condition: Each Mission participant acknowledges that any medical treatment that they may require during the course of this Mission, and any associated expenses, will be his or her sole financial responsibility and not that of Agent or FIDF. Release and Indemnification: By signing and submitting this Registration, each Mission participant acknowledges that he or she is aware of the risks inherent in overseas travel and has assumed the risks of participating in the Mission. These risks include, but are not limited to, personal injury, property damage, or death resulting from accident, illness or acts of terrorism. Each Mission participant has had an opportunity to read the current United States Department of State s Travel Warning for the Mission destinations and itinerary and has been apprised of the availability of updated Travel Warning information at He or she will abide by security directives issued by Agent, Sponsor or their representatives during the course of the Mission. He or she understands that any travel outside of the planned itinerary will be at his or her own risk and Agent and Sponsor will not be responsible for his or her safety or security. Each Mission participant acknowledges that he or she is primarily responsible for his or her own safety and security while on the Mission. In consideration of being permitted to participate in the Mission, each Mission participant does, for himself or herself and for his or her heirs, executors, administrators and assigns, release, discharge, indemnify and hold harmless Agent and Sponsor and their employees, officers, directors, partners, shareholders, agents and contractors, and their successors and assigns, from and against each and every claim arising during or in connection with the Mission and by reason of any bodily injuries (including emotional injuries), death or property loss or damage resulting, or alleged to result from, any accident, incident, or occurrence, and whether based on negligence, breach of contract or other cause or principle of law, as a result of his or her participation in the Mission or any activities related or connected thereto. This Registration form, including this release, contains the entire agreement between the parties and supersedes any other understandings, oral or written, concerning the Mission. If any portion of this release is held to be invalid, it is agreed that the remaining provisions shall continue in full force and effect. Each Mission participant affirms that he or she has read this document, understands its content, has had an opportunity to consult with his or her counsel, and recognizes it to be a legal, binding and enforceable contract. The signature of each Mission participant is required. Participant 1 signature: Participant 2 signature: Media Release: By signing and submitting this Registration each Mission participant affirms FIDF to use his or her name and to use photographs and/or sound and image recording of him or her for the marketing and/or promotion of FIDF s cause. I further rele ase FIDF, its agents, employees, officers and directors from any all claims that I may have for any cause of action arising out of the use of his or her name and/or image. Participant 1 signature: Participant 2 signature: Please complete this form and send to: Elena@mosaic tours.com