MABAT PLATINUM

PERSONAL INFORMATION:
Title:
Full name: *
Company name/ institution:
Primary mailing address: *
City, state, zip:
Country
Day time telephone:
Evening telephone:
Mobile telephone:
E-mail Address: *
Fax number:
Occupation:
Referred to Mabat by:
Have you been to Israel before:	yes no
Dates of trips:
Do you have relatives in Israel?	yes no
Jewish:
Christian:

FLIGHT INFORMATION:
Arrival details:(Flight info, time, day, date)
Departure details:(Flight info, time, day, date)

NAMES AND AGES OF ALL PARTICIPENTS:
Parents:
Child:
Child:
Child:
Child:
Parents:
Child:
Child:
Child:
Child:
Parents:
Child:
Child:
Child:
Child:

THE TOUR:
Purpose of the trip:
Special interests:	Nature Arts Culture Other
Adventure interests:	Rappelling Hiking Rafting Diving Horseback Riding Camel / Donkey Rides
Home hospitality with:	Kibbutz family Druze Youth village New immigrants Soldiers
Other interests:	Meeting with soldiers Museum curators

HOTELS:
Hotel level:
Preferences by hotel name:
Preferences by category of rooms:
Room requirements	Single Double Triple Suite
Special dietary requirements:

BAR/ BAT MITZVAH:
Name of child in English:
Name of child in Hebrew:
Birthday, English date:
Birthday, Jewish date:
Names of parents in Hebrew:
Will he/she also have a Bar/Bat Mitzvah in the USA:	yes no
Will he/she read Torah in Israel:
Number of guests (Israeli, American?):
Preferred time, day, date:
Meal preference:	Brunch Lunch Dinner
Would you like music at the meal?
Do you need a photographer:
Are you in need of services of a Rabbi:
Comments/ special Bar/Bat Mitzvah requests:
Other important information / special requests:


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