Women's Philanthropy Journey to Morocco Simple Registration Page

Registration Form for Women’s Philanthropy Morocco Trip 2024

General Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Cellphone(Required)

Email(Required)

Passport Information

Name(Required)

First Middle Last

As it appears on your passport. Please confirm that your passport expiration day is valid for six months from the date we return from Morocco (May 15, 2024).

Birthdate(Required)

Passport Number(Required)

Passport Issue Date(Required)

Passport Expiration Date(Required)

Country of Issue(Required)

Please upload a copy of your passport(Required)

Max. file size: 50 MB.

Additional Trip Information

Would you like a single or a double room?(Required)

Single room (supplement of $700)

Double room

Who would you like to be your roommate?(Required)

Do you have any dietary restrictions or allergies we should know about?(Required)

Yes

Please tell us about your dietary restrictions or allergies so that we may accommodate.(Required)

Do you have any medical limitations or concerns?(Required)

Yes

Please tell us about your medical limitations or concerns so that we may accommodate.(Required)

Is there anything you would like us to know?

Please let us know your level of Shabbat observance.(Required)

What is your t-shirt size?(Required)

Are you a member of a synagogue?(Required)

Yes

Please let us know which synagogue you belong to.(Required)

Emergency Contact Information

Name(Required)

First Last

Relationship(Required)

Email(Required)

Cellphone(Required)

Payment Information

Trip Deposit

Price:

Total

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name