Israel Faith Identity Trip Registration
March 19th-26th, 2023 | 8 days/ 6 nights
please complete this form and send it with a $350 nonrefundable/nontransferable deposit (per person). passport copy and picture to: Pan de Vida Travel, PO Box 189, Berrien Springs 49103
First Traveler
*
First Name
Last Name
Age
Gender
Please Select
Female
Male
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Birthplace
Passport Country
Passport Number
Religious Affiliation
Dietary Preferences
Please Select
Vegetarian
Vegan
Is this your first trip to Israel?
Please Select
yes
no
If not when was your last visit there?
Emergency Contact First Traveler
please provide the information below
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Emergency Contact Email
*
example@example.com
Are you adding a more travelers to your registration?
Please Select
Yes
No
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Second Traveler
please provide the information for the second traveler
First Traveler
First Name
Last Name
Age
Gender
Please Select
Female
Male
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Birthplace
Passport Country
Passport Number
Religious Affiliation
Dietary Preferences
Please Select
Vegetarian
Vegan
Is this your first trip to Israel?
Please Select
yes
no
If not when was your last visit there?
Would you like to Add a 3rd traveler?
please add another travel
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Third Traveler
please provide the information for the third traveler
Third Traveler
First Name
Last Name
Age
Gender
Please Select
Female
Male
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Birthplace
Passport Country
Passport Number
Religious Affiliation
Dietary Preferences
Please Select
Vegetarian
Vegan
Is this your first trip to Israel?
Please Select
yes
no
If not when was your last visit there?
Would you like to Add a 4th traveler?
please add another travel
Second Traveler
please provide the information for the Second traveler
Second Traveler
First Name
Last Name
Age
Phone Number
Please enter a valid phone number.
Gender
Please Select
Female
Male
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Emergency Contact Second Traveler
please provide the information below
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Emergency Contact Email
example@example.com
Trip Details
Please read the following PDF carefully for details on the trip.
PLEASE READ- Information for Faith Identity Trip
Please check all boxes that apply:
*
Please match me up with another single going on the trip for $50 administration fee (if no other single is available, I understand I am subject to the single room surcharge) Ask about triple occupancy.
I wish to have a room all to myself (single room surcharge of $500 main tour plus $200 for the pre extension and $200 for the post extension tour applicable)
I understand that I should arrive and leave from Tel Aviv if doing main tour alone. If doing pre-extension, I should arrive in Cairo, Egypt and leave from Amman if doing post-extension.
I understand I am responsible for airport-hotel transportation fees unless previously requested and paif for. Welcome dinner at hotel is 7:00 p.m.
I want Pan de Vida to include( ALL) my Airfare, and Pick up Drop Off at additional cost. Here is a recent picture and a copy of the passport page with my picture for identification. (I understand I may also attach a digital pictures to an email and send it to info@travel.ppvida.com ).
I am in good health. I understand that the HolyLand Tour is a rigorous trip with some walking, with lots of standing while sightseeing. I also realize I will have to carry my own bags — sometimes up stairs. (Those suffering any chronic disease should consult a physican to gain clearance).
I understand that I will be responsible for the care of the audio transmitter and earphone issued me. In case of damage or loss of the transmitter I understand that I will pay for repair, or $135 for a replacement.
I decline the offer to purchase insurance. I understand that I am solely responsible for any delays, cancellation penalties, sickness, accidents and out-of-pocket expenses incurred. This waiver confirms that I voluntarily decline travel insurance for this tour. I understand I am solely liable and I hereby release Pan de Vida Travel and its agents from any and all liability associated with my failure to purchase travel insurance and I made the choice to decline insurance coverage.
I accept to pay $100 travel insurance per person. That includes trip cancellation due to weather or mechanical malfunction, personal property and medical benefit.
I allow Pan de Vida to use my credit card to pay extra expenses that may depend on me
I have read the terms and conditions of the tour. Please enroll me now.
Other
If not rooming with a family member, I wish to room with
enter name of requested roomie
Signature First Traveler
*
Clear
Signature Second Traveler
Clear
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PAYMENT OPTIONS
Please Carefully look through the options listed below to consider your travel plans.
My Products
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( X )
Main Tour
Per Person
$
1,999.00
Quantity
1
2
3
4
5
6
7
8
9
10
Airfare Departs from NYC, LAX, SFO, or ORD*
per person
$
899.00
EARLY BIRD COUPON CODE
For youth 35 and under- for first 50 people that register by July 1st, 2022 per person.
$
Free
Early Bird Coupon Code
For Adults- For first 50 people that Register by July 1st, 2022
$
Free
Business Class Upgrade
Based on availability from select cities in addition to airfare. ONE/ Each Way per Person.
$
999.00
Quantity
1
2
3
4
5
6
7
8
9
10
Insurance
per person
$
100.00
Quantity
1
2
3
4
5
6
7
8
9
10
Scheduled Airport Shuttle Pick Up**
Per person
$
40.00
Quantity
1
2
3
4
5
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7
8
9
10
Scheduled Airport Shuttle Drop Off**
Per Person
$
40.00
Quantity
1
2
3
4
5
6
7
8
9
10
PRE-Extension in Egypt
5 days, 4 nights Per Person
$
899.00
Quantity
1
2
3
4
5
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7
8
9
10
POST-Extension in Jordan
3 days, 3 nights, Per Person
$
899.00
Quantity
1
2
3
4
5
6
7
8
9
10
Main Tour Single Room Supplement
Per Person
$
500.00
Quantity
1
2
3
4
5
6
7
8
9
10
Pre-Extension Single Room Supplement
$
200.00
Post-Extension Single Room SupplementC
Per Person
$
200.00
Quantity
1
2
3
4
5
6
7
8
9
10
Customary TIPS***
Per Person. Please select all that apply. Main Tour:$60, Pre-Extension: $25, Post-Extension: $25
$
Free
tour types
Main Tour
Pre-Extension
Post Extension
Quantity
0
1
2
3
4
5
6
7
8
9
10
Premium Bus Seating
$
100.00
Credit Card Info
please carefully add your credit card information. There is a 4% using credit/ debit card fee.
Credit Card Type
Credit Card Number
Expiration Date
-
Month
-
Day
Year
Date
CVV:
Name as it appears on Card:
First Name
Last Name
Payment Amount $
US dollars $
Cardholder Signature
Clear
Credit Card Billing Address
please add your billing address
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Initials
Thank you!
phone: +1(248)275-1050 | PO Box 189 Berrien Springs MI 49103- info@ppvida.com- www.travel.ppvida.com
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