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Christ at the Checkpoint – 2012

Please fill out the information below to register now!

Project Information

Please choose one of the following:

OPTION 1 – Conference Fee with hotel, transportation and special tours ($1175)
March 3-10, 2012 (8 days/7 nights)
OPTION 2 – Conference Fee with optional 2-day Jerusalem Tour ($1490)
March 1-10, 2012 (10 days/9 nights)

OPTION 3 – Conference Fee with Full Holy Land Tour ($2190)
February 28-March 10, 2012 (12 days/11 nights)

*PLEASE NOTE
Once you have registered an email will be sent with payment instructions and optional trip cancellation insurance information.
 
Personal Information (as it appears or will appear on your passport)
First Name
Middle Name
Last Name
Preferred Name
Title
Date of Birth (mm/dd/yyyy)

E-mail Address
Street Address
City
State
Zip
Home Phone
Mobile Phone
Work Phone
Your Church or Organization/School
Roommate
     
     
Passport Information
Do you have a passport?
(if applied for, select no)
Yes No
Passport Expiration Date (mm/dd/yyyy)
 
     
Emergency Contact/Medical Information
Emergency Contact Name
Emergency Contact Phone Number
Do you have any allergies or medical conditions?
Yes No
If yes, please explain
     
Life Insurance Beneficiary Information
Name (if different from your emergency contact)

Included in each participant’s cost is a nominal life insurance policy, please list your beneficiary.
     
Terms of Registration
Please read the terms of registration and select your response below.


I accept       Initials
 
 
 

 

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