Please fill out one form per family.
Travel Information
Traveller 1
Last Name
First Name(s)
Gender
Male Female
Traveller 2
Last Name
First Name(s)
Gender
Male Female
Additional Travellers - Number of additional travellers
Names & Relationship of additional participants
Eg. Abe Cohen - Husband, Ruth Cohen - Daughter
Passport details of additional participants
Contact Information
Address
City
State/Zip
Home Phone
Cell Phone
Email
Payment Information
TERMS OF PAYMENT (see full description of package under the "Pricing" tab)
- The cost for the trip comes to $3300 per person (double occupancy). Single Supplement $700. Additional Child (under 12) $2800.
- Deposit of $1300 per participant to confirm reservations required by November 1, 2012.
- Final and full payment is required required by December 15, 2012.
I will be paying my deposit I will be paying for my trip in full
Charge Amount
Card Type
Card Number
Expiration Date
CVV What's this?
Comments
RESPONSIBILITY & INSURANCE
Chabad of Port Washington will not be held responsible for any loss of personal items or damage, and therefore, we STRONGLY RECOMMEND you purchase valid travel insurance which covers, trip cancellation, all health issues and luggage loss or damage.