REGISTRATION FORM Kindly complete one registration form per person traveling. Please refer to secure.ayelet.com/chwoctober2017.aspx for more information about the October 2017 CHW Centennial Trip to Israel: Celecation: Celebration Education Vacation Date of Arrival in Israel (mm/dd/yyyy): Please register me for: 5-DAY TRIP: October 16 th October 20 th, 2017 Cost: $2,275 USD per person based on double occupancy (Additional $700 USD for single occupancy) 10-DAY TRIP: October 16 th October 26 th, 2017 Cost: $4,100 USD per person based on double occupancy (Additional $1,400 USD for single occupancy) PERSONAL INFORMATION First Name: Last Name: Middle Name: Name for Badge: Member of CHW: Yes No Mr. Mrs. Ms. Miss Dr. Male Female Home Address: City: Province: Postal Code: Phone: Home:( ) Work:( ) Fax:( ) Mobile/Cell (CDN):( ) Mobile/Cell (Israel):( ) Email: Date of Birth (mm/dd/yyyy):
PASSPORT INFORMATION Passport Number: Citizenship: Date of Expiry (mm/dd/yyyy): Place of Issue: PLEASE SEND A PHOTOCOPY OF YOUR PASSPORT WITH YOUR REGISTRATION FORM. PLEASE CHECK YOUR PASSPORT S EXPIRATION DATE. Every visitor to Israel must hold a valid passport which must be valid for at least 6 months after return from Israel. Visitors may remain in Israel for up to three months from the date of arrival, subject to the terms of the visa issued. EMERGENCY CONTACT (EC) INFORMATION: Emergency Contact (EC): Relationship to EC: EC Email: EC Phone Number: ( ) SPECIAL NEEDS I am physically able to climb stairs on/off the bus without assistance. Yes No If no, please provide details: Special Needs: You are required to advise us of any special medical needs or physical limitations, including walking limitations, wheelchair assistance, severe allergies, etc: Allergies: Please specify any allergies, food related or otherwise. Please explain the severity of allergies, for example, if an EpiPen is required or not: Dietary Restrictions during the tour:
HOTEL INFORMATION Room Type: Single Supplement (5-Day Trip $700 USD & 10-Day Trip $1,400 USD) Double (two in a room): Roommate Name: *Please note that we cannot guarantee roommate requests TRANSFERS Please contact me about hotel upgrade options. Additional charges will apply. Please contact me about options for additional hotel nights. Additional charges will apply. Royal Beach Hotel, Tel Aviv from October 16 th -October 20 th Cramim Resort & Spa, Kiryat Anavim from October 20 th -October 22 nd David Citadel, Jerusalem from October 22 nd -October 26 th For those arriving and departing on the designated arrival (16 th ) and departure dates (20 th or 26 th ) of October, airport transportation is included. Please provide your flight information below. Arrival Information Arrival Date: Airline/Flight Number: Drop Off Location ( ie Hotel Name): Departure Information (Pick up will be from David Citadel Jerusalem) Departure Date: Airline/Flight Number: Flight Departure Time: I am arriving on a day other than the designated arrival date (Oct 16 th ) and would like an arrival transfer. (Fill in details above) I am departing on a day other than the designated departure dates (Oct 20 th or 26 th ) and would like a departure transfer. (Fill in details above) *Cost for Group Transfer (1-4 people on same flight): Airport to Tel Aviv/Tel Aviv to Airport: $125 USD/ group each way Airport to Jerusalem/Jerusalem to Airport: $170 USD/ group each way *Cost for Group Transfer (5-7 people on same flight): Airport to Tel Aviv/Tel Aviv to Airport: $155 USD/ group each way Airport to Jerusalem/Jerusalem to Airport: $199 USD/ group each way *Please note: If you have requested an airport transfer to and/or from the airport, final details of your transfer will be provided within 48 hours prior to your arrival/departure.
10-DAY TOUR: ADDITIONAL TOUR OPTIONS *May only select ONE option tour for Saturday October 21 st Please send me the Spa Treatment Menu and Pricing for Cramim Resort & Spa as I am interested in having spa treatments during my stay. Note: This is not included in the trip package and additional charges apply. Optional Tour 1: Walking Tour of Kibbutz Anavim Saturday October 21 st Note: There is no additional charge for this tour. Enjoy a guided walking tour of the historic Kibbutz Anavim and the refet (dairy cowshed.) Kibbutz Anavim was the first kibbutz established in the Judean Hills. It was built at the beginning of the last century and was purchased from the neighbouring Arab village of Abu Gosh. The kibbutz was a command centre during the War of Independence and of the Harel Brigade. The dairy cowshed, the main building at the entrance to the kibbutz, was built in 1920. Following the tour of Kibbutz Anavim, we will visit the military cemetery that is the resting place of brave heroes who fell in action. We will return to the hotel via the vineyards of the kibbutz. The tour will begin at 11:00AM. It is a two hour walking tour. Participants will depart from the hotel, with a guide, and return to the hotel by 2:00PM. Please note that there is a lot of walking, roughly 2.5 3KM. Lunch available at hotel. For those interested in this tour as well as the spa treatment, there is time to accommodate both.
Optional Tour 2: Visit to Har Adar Saturday October 21 st Note: There is no additional charge for this tour. The group will stop for lunch at own cost. Enjoy a tour of Har Adar, also called Radar Hill, for the World War II British military installation which had anti-air radar for the protection of Jerusalem. The installation was handed over to the Jordanian Arab Legion on May 10, 1948, prior to the second phase of the War of Independence. There were 23 failed attempts by the Palmach s Harel Brigade to conquer it. It was finally captured in the Six-Day War. Continue to Al-Qastal, a key position on the Jaffa-Jerusalem road, used by Arab forces to attack Jewish relief convoys. Following this, we will hike Sataf in the Jerusalem Hills and explore its ancient agricultural terraces. Visit the Scroll of Fire, one of the most beautiful sculptures in Israel; located in the single largest memorial to the Holocaust in the world. The memorial, known as The Martyrs Forest, is an important work, rich in detail and history. It tells the story of the rebirth of the nation from the Holocaust up to the Six-Day War. The sculpture commands a spectacular view of its surroundings. The tour will begin at 11:00AM. It is a four to five hour tour. Participants will depart from the hotel, by bus and with a guide, and return to the hotel by 4:00PM. Please note that there is a lot of walking, roughly 2.5 3KM. For those interested in this tour as well as spa treatments, there is time to accommodate both. Optional Tour 3: Day Trip to Masada and the Dead Sea Saturday October 21 st Note: Tour is not included in the trip package and additional charges apply. The trip costs $120 USD. Participants will depart via the Judean Hills towards the Dead Sea, the lowest place on Earth. Drive past the Qumeran caves where the Dead Sea scrolls were found. Continue along the shores of the Dead Sea to Masada. There we will learn about the heroic story of the Jewish fighters. Ascend by cable car and tour the mountain fortress built by King Herod, where the Zealots of the first century made their last stand against the Romans. View the remains of the walls, palaces, synagogue, water cisterns, mosaic floors, Roman baths, and other findings. We will then descend by cable car. Continue to the Dead Sea; enjoy the opportunity to float and cover yourself with the mineral rich, therapeutic Dead Sea mud. We will then return to the hotel. Participants will depart from the hotel at 7:30AM. You will be accompanied by a guide. Please note that it is highly recommended to wear comfortable walking shoes, a hat, sunscreen, a bathing suit, and to bring a towel. Participants will return to the hotel around 4:30PM. Please note, lunch is not included in the price; however, there will be time to stop and purchase lunch. For those interested in this tour as well as the spa treatment, there is time to accommodate both.
Optional Tour 4: Bike tour of the Judean Hills Saturday October 21 st Note: Tour is not included in the trip package and additional charges apply. Trip cost $320 USD. Spend a day biking through wide valleys endless vineyards of the Judean Hills, on a tour led by DuVine Cycling & Adventure Co. Studded with archaeological and historical sites traversed by great biking roads, the Judean Hills set the scene for a fantastic day of biking, complete with a picnic lunch and a wine tasting at a local winery. Includes lunch and taxi transfer. DEPOSIT PAYMENT * A deposit of $500.00 USD per person is required. Charge to my credit card: $ USD I wish to pay by Cheque (USD). Please make payable to Ayelet Tours and mail to: AYELET TOURS 19 AVIATION ROAD ALBANY, NEW YORK 12205 U.S.A. Credit Card Details: Card Type: Discover Master Card Visa American Express Card owner s name as it appears on credit card: Card Number: Date of Expiry (mm/yyyy): CID Number (3 digit code/4 digits on AMEX): Card Billing Address (if different than home address): Address: City: Province: Postal Code:
Full Payment is due 60 days prior to departure. I hereby authorize Ayelet Tours to charge the credit card provided above. I understand that my payment in USD, by cheque or credit card, is necessary in order to reserve hotel accommodations and other services provided. I further recognize that these payments are for services (i.e., hotel, touring, etc.) and are not tax deductible as charitable contributions. Card Holder's Name: Card Holder s Signature: *Please Note: $500 deposit is non-refundable if you cancel after April 1 st, 2017 TRAVEL INSURANCE Please note that travel insurance is not included in the trip package. Ayelet Tours strongly recommends the purchase of travel insurance, including trip cancellation and luggage insurance. Please log into the Ayelet Tours website at http://ayelet.com/israel-travel-insurance/ for details. Keep in mind that the terms of any insurance policy are determined by the insurance carrier and that the insurance carrier makes all determinations regarding the insurance policy s benefits. Canadian Hadassah-WIZO (CHW) has no control over, and accepts no responsibility, for any insurance policy in any way, including, but not limited to its terms, scope of coverage, administration, determination of benefits, or payment of claims. LUGGAGE Luggage allowance policies are set by the airlines and may change without prior notice. Please contact your airline(s) for the most current luggage allowance policy. HEALTH By completing and returning this registration form, I hereby certify that I do not have any mental, physical, or other condition, or disability that could create a hazard for me or other participants. PHOTOS I hereby give CHW permission to use photos and/or videos taken throughout the duration of the trip for marketing purposes.
Disclaimer: IGT and Ayelet Tours, LTD. Act only as agents for the tour members in making arrangements for hotels, transportation, touring, restaurants or any other services in connection with the itinerary. We will exercise reasonable care in making such arrangements. However, we do not assume nor bear any responsibility or liability whatsoever for any injury, death, damage, loss, accident, delay or irregularity to person and property because of an act, sickness, or circumstance beyond our control or an act of default of any hotel, airline carrier, restaurant, company, or person rendering any of the services included in the tour. The right is reserved to decline to accept or retain any tour participants should such person s health or general comportment impede the operation of the tour or detrimentally affect the other tour participants. If you are not registering online, please mail original registration form to: 19 AVIATION ROAD ALBANY, NEW YORK 12205 U.S.A. Need further assistance? Contact Grace at Ayelet Tours: Phone: (800) 237-1517 ext. 338 Fax: (518)783-6003 Email: grace@ayelet.com We recommend you retain copies of your cheque, forms, and documents. CANCELLATION REGULATIONS $500 USD deposit is non-refundable if you cancel after April 1 st, 2017 $750 USD penalty if you cancel within 60-31 days prior to the trip 100% penalty if you cancel within 30 days prior to trip or if you do not show up for the trip Note: Advertised Centennial Trip pricing is generally based on 35 paying participants per bus. Group size supplement may apply for smaller groups. Requests for cancellation must be made in writing by email to the following contact email: Grace@ayelet.com Each trip is priced as a package and no refund or discount will be made for any part of the trip/activity in which you choose not to participate. No refunds will be made if you leave the trip voluntarily or involuntarily after the date of departure. Participants may also be subject to any cancellation fees assessed by the purveyors of services, including hotels.
I understand that my reservation will be accepted subject to the above terms and conditions. I have read, understand, and agree to the above terms and conditions and understand that this document constitutes an agreement solely between the undersigned participant and Ayelet Tours LTD. and that CHW is not a party hereto. Participant's Name: Participant's Signature: Date: