Bless Israel Tour with Sandra Levitt Registration Form

Bless Israel 11 Day Tour Registration Form

Please complete the form below. Mandatory fields marked *

Passenger Details

Name * (as it appears on your passport)
Address *
City*
State *
Zip *
Work Phone *
Alternate Phone
Email Address *
Is this address also your credit card billing address? Yes No

Passport Information

Please send a copy of your Passport Photo Page

(You may fax a copy to 972.233.1982)

Special Travel Arrangements

Roommate (if known)
Special Celebrations
Others traveling with you

I prefer single accommodations at the additional cost noted in the brochure

Medical Information

Any special conditions or medications:

Emergency Contact

Name
Address
City
State
Zip
Work Phone
Mobile Phone

Payment Information Please choose your method of payment: Credit Card or Check

Credit Card (A $300.00 per person deposit is required with registration)

I authorize Ideal Travel and Tours to

Charge $
Credit Card
Credit Card Number
Expiry Date
Name on the Card

Check

Make Checks payable to:
Ideal Travel & Tours
14785 Preston Road, Suite 195, Dallas, Texas 75254

* I have read and agree to the Tour Terms & Conditions.