PARTICIPANT 2 (exactly as on passport) Name: (Title/First/Middle/Last) Place of Birth: Address: (Street/City/State/Zip)
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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 or Fax: (305) or Tel:(305) Deadline for registration is October 12. Forms received after October 31, will be confirmed according to availability. Note the entire cost of the mission is not-deductible. 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) Are you a Veteran? PARTICIPANT 2 (exactly as on passport) Name: (Title/First/Middle/Last) Relationship to above participant 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) Are you a Veteran? *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 $4,900 based on double occupancy $6,150 based on single occupancy 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 6345 Collins Ave Miami Beach, FL or tours.com or Fax: (305) or Tel:(305) Based on Double Occupancy $4,900 per person x $ _ Based on Single Occupancy $6,150 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 Elena Zamudio at Mosaic Tours who will process the request and advise you costs. Departure Date Airline Flight Arrival City Departure Time Class Accommodation Upgrades: Upgrades are available on the following page 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 Please note, deviation can't be paid with American Express. King David, Jerusalem: The mission is based on Deluxe New City rooms at the King David hotel. Please indicate if you would like to upgrade your room from the list below: King David Hotel Nov 9 11, 2018 * Rates are supplement per room for all 3 nights in Jerusalem and include breakfast Room type Floor Supplement for Jerusalem* New City Top (Renovated) 5 6 TBA Old City 1 4 TBA Old City Top (Renovated) 5 6 TBA Pre Accommodations King David Hotel Please indicate your room preference from the list below: Dates of stay Room Type Floor Single Occupancy Double Occupancy New City 1 4 TBA TBA New City Top (Renovated) 5 6 TBA TBA Old City 1 4 TBA TBA Old City Top (Renovated) 5 6 TBA TBA Incidentals: To hasten the hotel check out process, we ask to give the hotel your credit card number in advance in order to charge any incidentals you might have accrued. Please check the relevant box if you agree to this stipulation. Yes No Please note, if you decide not to give your card number, it will be your responsibility to check out the day we leave. 3
4 Please note, deviation can't be paid with American Express. Hilton Hotel, Tel Aviv: The mission is based on Classic rooms at the Hilton hotel. Please indicate if you would like to upgrade your room from the list below: Hilton Hotel Nov 14 16, 2018 * Rates are supplement per room for 2 nights in Tel Aviv Room type Floor Supplement for Tel Aviv Executive Sea View TBA Vista Sea View TBA Additional nights post mission Nov Please indicate your room preference from the list below: Dates of stay Room Type Floor Single Occupancy Double Occupancy Deluxe Sea View 3 10 TBA TBA Executive Sea View TBA TBA Vista Sea View TBA TBA Incidentals: To hasten the hotel check out process, we ask to give the hotel your credit card number in advance in order to charge any incidentals you might have accrued. Please check the relevant box if you agree to this stipulation. Yes No Please note, if you decide not to give your card number, it will be your responsibility to check out the day we leave. 2. How did you learn about the delegation? My local chapter FIDF Website/ Other 4
5 Participant 1 bio: Participant 2 bio: My local chapter How did you learn about the Mission? FIDF Website/ Other 5
6 PAYMENT* Final payment due by October 12, 2018 Deposit (due with application) $1,200 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 September 30, 2018 incur a $1,200 cancellation fee, per participant. Cancellations between October 1 October 20, 2018 incur a $2,000 cancellation fee, per participant. Cancellations after October 21, 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 CACELLATION 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. 6
7 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 Zamudio, the FIDF Mission Liaison, from Mosaic Tours 6345 Collins Ave Miami Beach, Fl or Elena@mosaic tours.com or Fax: (305) or Tel:(305) Deadline for registration is October 12. Forms received after October 12, will be confirmed according to availability. PLEASE SUBMIT A COPY OF THE PHOTO PAGE OF YOUR PASSPORT WITH THIS APPLICATION 7
PARTICIPANT 2 (exactly as on passport) Passport #*: Date of Issue: Home/Office #: Date of Expiration: Nationality**: Mobile #:
Please complete this form and send to: Elena Zamudio, the FIDF Mission Liaison, from Mosaic Tours 6345 Collins Ave Miami Beach, Fl 33141 or Elena@mosaic tours.com or Fax: (305)865 6522 or Tel:(305)865
More informationPARTICIPANT 2 (exactly as on passport) Date of Birth: Name: (Title/First/Middle/Last) Place of Birth: Name as you would like it to appear on name tag:
Please complete this form and send to: Elena Zamudio, the FIDF Mission Liaison, from Mosaic Tours 6345 Collins Ave Miami Beach, Fl 33141 or elena@mosaic-tours.com or Fax: (305)865 6522 or Tel:(305)865
More informationTheir job is to look after Israel. Ours is to look after them. 1
Please complete this registration form and send to: Elena Zamudio, the FIDF Delegation Liaison, from Mosaic Tours 6345 Collins Ave Miami Beach, Fl 33141 or Elena@mosaic tours.com or Fax: (305)865 6522
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