MARCH OF THE LIVING - ADULT APPLICATION

MARCH OF THE LIVING - ADULT APPLICATION
An application needs to be completed by each individual. A $1,500 deposit is required at time of application. This deposit is refundable until November 31, 2024, upon request, dated and in writing to galboukrek@jewishbroward.org. The cancelation fee schedule can be found at the end of this application. The application will need to be completed in one sitting. Have your emergency contact information and passport information available prior to beginning your application. (if you do not have a passport, or one which expires prior to October 27, 2025), please apply immediately as it can often take a long period of time for processing). If necessary, submit your application without passport information.

You will be required to submit a digital headshot via email to galboukrek@jewishbroward.org
Last Name*
First Name*
Middle Name
Program Fees*

Poland April 22 - April 27, 2025 $5646**Single Room $875
**Airfare to departure/return city is the responsibility of each participant. Based on double occupancy

Fee includes: Kosher meals, 4/5 star hotel accomodations, land transportation, all admissions, tips, and regalia.
I will room with
I would like you to find me a roommate (note we will make our best effort; however if a roommate cannot be found, you will be responsible for the single room rate)

Yes
Name you prefer to be called*
Will appear on your ID/Security Badge
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*

Area CodePhone Number
Home Phone

Area CodePhone Number
E-mail*
example@example.com
I prefer to be contacted by*

EmailTextEitherBoth
Date of Birth*

MonthDayYear

PASSPORT & CITIZENSHIP INFORMATION
A copy of the inside page of your passport and a digital head shot or 2 passport size pictures must be submitted. They should be sent to galboukrek@jewishbroward.org Remember passports must expire after October 27, 2025.
Country of Citizenship*
Country of Passport with which you will travel*
Full Name as it appears on your passport
Passport Number
Expiration Date

MonthDayYear
If you have a passport which has not expired and does not expire prior to November 3, 2020, please upload a copy of the inside page (the one with the picture)

Browse Files

Cancelof
Are you a citizen of Israel?*

YesNo
Israeli Passport Number
Expiration Date

MonthDayYear

EMERGENCY CONTACT INFORMATION
Emergency Contact Full Name*
Relationship*
Cell Phone*

Area CodePhone Number
Second Phone

Area CodePhone Number

APPLICANT AGREEMENT AND UNDERSTANDING

By placing your name below you understand you are providing medical and other information to the providers of the March of the Living (International March of the Living, Broward County March of the Living and the Jewish Federation of Broward County). The undersigned represents that all of the information contained in such forms is true and correct. All medical conditions and medications are true and correct. Omissions or misstatements are at my risk and that of my physician(s) or therapist(s). The undersigned hereby authorizes the leadership of the March of the Living and/or its providers to obtain treatment as it, in its sole and absolute discretion, deems necessary and advisable. The costs of any medical treatment provided shall be the responsibility of the undersigned.

The undersigned agrees to hold the March of the Living, Inc. ("March"), the Broward County March of the Living, and/or the Jewish Federation of Broward County (Federation), as well as any other organization, harmless from any claim, loss, damage, bodily injury, personal injuries, including emotional trauma, known or unknown, death, liability or expense (including attorney's fees) which the undersigned might sustain/alleged sustain or incur/alleged incur in connection with, as a result of, or by reason of their participating in the March or any of the activities relating thereto, whether based upon the negligence or breach of contract by any of the above mentioned organizations/agencies of their representatives.

The organizations sponsoring the March operate the tour offered under this program only as agents of the airline, bus operators, hotel facilities, and others which provide the actual arrangements, and are not liable for any act of omission, delay, injury, loss, damage or nonperformance occurring in connection with these arrangements.

It is further noted by the undersigned that while all food on the March of the Living is kosher, we cannot always provide for all special dietary needs.

By placing my name below, I agree to abide by all rules and regulations as set forth by the International March of the Living, Broward County March of the Living and/or the Jewish Federation of Broward County.

In addition, I consent, for all purposes, to being interviewed, photographed, videotaped and/or filmed by the Broward County March of the Living, the Jewish Federation of Broward County and/or the March of the Living and its affiliates, for use in all media and in all manner of promotion, including, but not limited to, marketing, advertising, editorial and display. I further consent to allowing the Broward County March of the Living, the Jewish Federation of Broward County, and/or the March of the Living and its affiliates to make use of my writing, spoken and written words, art work, music and/or photographs pertaining to the March of the Living.

I release the reporter/photographer/cameraperson/editor/staff and his/her nominees and designees, from liability for any violation of any personal or proprietary right I may have in connection with such sale, reproduction or use.
Agreement/Understanding*
Place full name here

JEWISH FEDERATION OF BROWARD COUNTY

March of the Living Adults 2025

PAYMENT / CANCELLATION POLICY

PAYMENT POLICY

The fees for the programs are listed at the top of the application.

A $1500 deposit is required with this application. It is fully refundable through November 31, 2024

50% of the balance is due by December 15, 2024

Balance of full payment due byFebruary 1, 2025

CANCELLATION POLICY - NON-REFUNDABLE AMOUNTS

If cancellation is between now and November 31, 2024	$0
If cancellation is between December 1 & December 31, 2024	$2,500
If cancellation is between January 1 & January 31, 2025	$3,500
If cancellation is between February 1 & February 14, 2025	$4,500
February 15, 2025 and after	No refund

All cancellations must be in writing and dated and sent to galboukrek@jewishbroward.org

We require the purchase of trip cancellation/interruption and medical insurance and will send required minimums and additional information upon receipt of application.

TERMS AND CONDITIONS

By placing my name below, I understand the payment/cancellation schedule. In addition, I understand the information contained in this application may be used by the International March of the Living and/or Broward County March of the Living and/or Jewish Federation of Broward County in conjunction with the March of the Living and its activities.

Link to pay the deposit will be on the submission page.

Please use your mouse to sign your name

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