Please complete this registration form and send to: Elena Zamudio, the FIDF Delegation Liaison, from Mosaic Tours 6345 Collins Ave. Miami Beach, Fl 33141 or Elena@mosaic-tours.com or Fax: (305)865-6522 or Tel:(305)865-6991 Deadline for registration is March 16, 2016. Forms received after March 16, will be confirmed according to availability. PLEASE SUBMIT A COPY OF THE PHOTO PAGE OF YOUR PASSPORT WITH THIS APPLICATION PARTICIPANT 1 (exactly as on passport) Name: (Title/First/Middle/Last) Name as you would like it to appear on name tag: Address: (Street/City/State/Zip) Date of Birth: Place of Birth: Email: Passport #*: Date of Issue: Home/Office #: Date of Expiration: Nationality**: Mobile #: Emergency Contact (Name/Relationship/Phone#) Shirt Size:(S/M/L) PARTICIPANT 2 (exactly as on passport) Name: (Title/First/Middle/Last) Name as you would like it to appear on name tag: Address: (Street/City/State/Zip) Relationship to above participant Date of Birth: Place of Birth: Email: Passport #*: Date of Expiration: Date of Issue: Nationality**: Home/Office #: Mobile #: Emergency Contact (Name/Relationship/Phone#) Shirt Size:(S/M/L) *Please note that your passport must be valid for at least 6 months following your return to the U.S. ** Those in possession of Israeli passports are subject to VAT on accommodation. Israeli law requires Israeli passport holders to enter Israel only on their Israeli passport even with dual citizenship. 1
Travel Packages All Travel Packages Are LAND ONLY If you are interested in deviating from the basic delegation package (upgrades, extensions, etc.) please contact Elena Zamudio from Mosaic Tours at Tel:(305)865-6991 or Elena@mosaic-tours.com. Please note that paying via Amex will incur a credit processing fee to be paid by card holder A May 5-13, 2016 Poland and Israel $10,900 per person based on double occupancy $2,095 single occupancy supplement Participant Name/s: Please continue to page (3) for additional information *The flight from Poland to Israel will be on an IAF airplane and is included in the cost of package A. Poland Only B May 5-9, 2016 $5,650 per person based on double occupancy $1,065 single occupancy supplement Participant Name/s: Please continue to page (5) for additional information Israel Only C May 9-13, 2016 $5,250 per person based on double occupancy $1,030 single occupancy supplement Participant Name/s: Please continue to page (6) for additional information 2
A Poland & Israel, May 5 - May 13, 2016 Flights*: Arrival to Poland, please indicate the date of arrival in Poland, not departure date from origin. Date Airline Flight Departure City Departure Time Arrival Time Class A transfer will be provided to participants arriving in Poland on April 16 th from the Krakow Airport to the hotel. *The flight from Poland to Israel will be on an IAF airplane and is included in the cost of package A. Departure from Israel to the U.S. Date Airline Flight Departure City Departure Time Arrival Time Class Rooming Assignments and Upgrades: If you are interested in deviating from the basic delegation package, (upgrades, extensions, etc.) please contact Elena Zamudio from Mosaic Tours at Tel:(305)865-6991 or Elena@mosaic-tours.com. Please note upgrades must be paid at time of booking in order to confirm. Room upgrades are non-refundable and are above and beyond the cancellation policy. Poland: The delegation is based on Classic rooms at the Sheraton Krakow Hotel. For any upgrade at the Sheraton Hotel, please contact Elena@mosaic-tours.com or Tel:(305)865-6991. Israel: The Delegation is based on Deluxe New City rooms at the King David hotel. Please indicate if you would like to upgrade your room from the list below: King David Hotel May 9-13, 2016 *Rates are per room for 4 nights and include breakfast, subject to availability King David Hotel, May 9 13, 2016 Room type Floor Supplement for the week- Rates are per room for 4 nights and include breakfast, subject to availability New City Top (Renovated) 5-6 $152 Old City Top (Renovated) 5-6 $806 Mini suite (Renovated) 5-6 $2910 3
Junior 1-4 $7570 Pre/Post Accommodations King David Hotel Please indicate your room preference from the list below: *Rates are per room per night and include breakfast, subject to availability Dates of stay Room Type Floor Single Occupancy* Double Occupancy* New City 1-4 $480 $500 New City Top (Renovated) 5-6 $510 $530 Old City Top (Renovated) 5-6 $660 $680 Mini suite (Renovated) 5-6 $1125 $1125 Junior 1-4 $1060 $1060 Incidentals: To hasten the hotel check out process, we ask to give the hotel your credit card number in advance in order to charge any incidentals you might have accrued. Please check the relevant box if you agree to this stipulation. Please note, if you decide not to give your card number, it will be your responsibility to check out the day we leave. Additional Information: If you are interested in taking part in the Pre Arrival package to Warsaw, Poland on May 3-5, 2016 please fill out page 8 or proceed to page 9 for payment, additional questions and information. Do you have any personal connection to the Holocaust? We encourage you to find if your family had any connection to these events as, during the delegation, we will have the opportunity to pay homage to the memory of family members that perished. 4
B Poland Only May 5 - May 9, 2016 Flights: Arrival to Poland, please indicate the date of arrival in Poland, not departure date from origin. Date Airline Flight Departure City Departure Time Arrival Time Class A transfer will be provided to participants arriving in Poland on April 16th from the Krakow Airport to the hotel. Departure from Poland. Date Airline Flight Departure City Departure Time Arrival Time Class Rooming Assignments: The delegation is based on Classic rooms at the Sheraton Krakow Hotel. For any upgrades/deviation at the Sheraton Hotel, please contact Elena@mosaic-tours.com or Tel:(305)865-6991. Incidentals: To hasten the hotel check out process, we ask to give the hotel your credit card number in advance in order to charge any incidentals you might have accrued. Please check the relevant box Y N if you agree to this stipulation. Please note, if you decide not to give your card number, it will be your responsibility to check out the day we leave. Additional Information: If you are interested in taking part in the Pre Arrival package to Warsaw, Poland on May 3-5, 2016 please fill out page 8 or proceed to page 9 for payment, additional questions and information. Do you have any personal connection to the Holocaust? We encourage you to find if your family had any connection to these events as, during the delegation, we will have the opportunity to pay homage to the memory of family members that perished. 5
C Israel Only May 9-13, 2016 Flights: Arrival to Israel, please indicate the date of arrival to Israel, not departure from the USA. Date Airline Flight Departure City Departure Time Arrival Time Class Departure from Israel. Date Airline Flight Departure City Departure Time Arrival Time Class Rooming Assignments: The Delegation is based on Deluxe New City rooms at the King David hotel. Please indicate if you would like to upgrade your room from the list below: King David Hotel May 9-13, 2016 * Rates are per room for 4 nights and include breakfast King David Hotel, May 9-13, 2016 Room type Floor Supplement for the week- Rates are per room for 4 nights and include breakfast, subject to availability New City Top (Renovated) 5-6 $152 Old City Top (Renovated) 5-6 $806 Mini suite (Renovated) 5-6 $2910 Junior 1-4 $7570 Pre/Post Accommodations King David Hotel Please indicate your room preference from the list below: *Rates are per room per night and include breakfast, subject to availability 6
Dates of stay Room Type Floor Single Occupancy* Double Occupancy* New City 1-4 $480 $500 New City Top (Renovated) 5-6 $510 $530 Old City Top (Renovated) 5-6 $660 $680 Mini suite (Renovated) 5-6 $1125 $1125 Junior 1-4 $1030 $1030 Incidentals: To hasten the hotel check out process, we ask to give the hotel your credit card number in advance in order to charge any incidentals you might have accrued. Please check the relevant box Y N if you agree to this stipulation. Please note, if you decide not to give your card number, it will be your responsibility to check out the day we leave. Please skip to page 9 for payment, additional questions and information. 7
Pre Arrival package to Warsaw, Poland May 3-5, 2016 Pre-Arrival Package May 3-5, 2016 Participant Name/s: $2,125* per person based on double occupancy $395 single occupancy supplement *Based on a minimum of 10 participants. Due to limited availability of rooms, please check availability before booking your flight to Warsaw The Pre Package includes: Meeting and assistance upon arrival at Warsaw airport Transfer to the hotel 2 nights including breakfast at the Bristol Hotel in a Superior room. Welcome dinner on Tuesday May 3 and dinner on Wednesday May 4 Lunch on Wednesday May 4 Full day sightseeing as detailed on the Itinerary All entrance fees and Service charges Transportation Warsaw-Krakow Arrival to the Sheraton Hotel in time for the welcome dinner Package does not include: Lunch on Thursday May 5 Alcohol at meals. 8
About you: 1. Please provide us with your travel cell number/s: Participant 1: Poland# Israel # Participant 2: Poland# Israel # 2. How did you learn about the delegation? My local chapter Website/Email Other 3. Is this your first time to Poland and/or Israel? N Y If No please share your previous experiences: 4. Do you have any restriction(s) such as impaired hearing, mobility, vision, etc. that require special arrangements, equipment, or assistance for you to participate in the delegation? N Y If Yes please specify: 5. Please write a short biography about yourself (occupation, interests, affiliations with FIDF and Israel in general and any other information your feel is appropriate). Please feel free to attach a separate page. 9
Participant 1 bio: Participant 2 bio: 10
Are you willing to be interviewed by reporters covering the Delegation? Y N Media Release: By signing and submitting this Registration each Delegation participant affirms FIDF to use his or her name and to use photographs and/or sound and image recording of him or her for the marketing and/or promotion of FIDF s cause. I further release FIDF, its agents, employees, officers and directors from any all claims that I may have for any cause of action arising out of the use of his or her name and/or image. Participant 1 signature: Date: Participant 2 signature: Date: PAYMENT* Final payment due by March 16, 2016 Applications received after March 16, will confirmed based on the availability Deposit (due with application) $3,000 per person x Additional Non Upgrade/Deviation Payment *Please note that paying via Amex will incur a credit processing fee to be paid by card holder $ $ Total $ Name: (as it appears on card): Visa/MC Card #: Exp. Date: Signature: Check enclosed (please make checks out to Friends of the IDF) FEE DOES NOT INCLUDE: Airfare transportation except for flight from Poland to Israel for those participating in both parts of the delegation; airport taxes, customs, and immigration fees; passports & visa fees; travel and baggage insurance; meals not included in the itinerary; after meal beverages ( house wine is included with dinner); personal expenses (laundry, mini bar, valet services, cables, phone calls, postages, etc.). Health, travel and baggage-insurance are the responsibility of each participant, and are not included in the delegation costs. 11
CANCELLATION POLICY: Cancellations up to January 16, 2016 incur a $1,850 cancellation fee, per participant. Cancellations between January 17 February 28, 2016 incur a $2,600 cancellation fee, per participant. Cancellations after March 1, 2016 incur a 100% cancellation fee, per participant. Regardless of date of cancellation, room upgrade and extra services are non refundable and are in addition to the standard cancellation. CANCELLATION POLICY - PRE-ARRIVAL PACKAGE: Cancellations up to February 15, 2016 incur a $1,000 cancellation fee, per participant. Cancellations after February 16, 2016 incur a 100% cancellation fee, per participant. *NOTE: ALL CANCELLATION FEES ARE NON-REFUNDABLE. ALL CACELLATION FEES WILL GO TOWARDS PAYING FIDF s COMMITMENTS TIED TO THE DELEGATION. ANY BALANCE OWED TO YOU BEYOND THE CANCELLATION FEE WILL BE REFUNDED TO YOU PER THE CANCELLATION SCHEDULE ABOVE. THERE WILL BE NO REFUNDS FOR UNUSED DELEGATION COMPONENTS OR SERVICES. Itinerary is subject to change based on IDF activities and availability of locations and presenters/hosts. The above prices include only those accommodations and activities that are listed in the itinerary. Additional terms conditions and waivers General: The arrangements for the Delegation for which you are registering ( Delegation ), including ground transportation, hotel accommodations, restaurants, tours and other features of the Delegation, have been made by Mosaic Tours ( Agent ) as agent for Friends of the IDF ( Sponsor ) which is the sponsor of the Delegation. Agent will exercise reasonable care in making these arrangements, but neither the Agent nor the Sponsor will assume or bear any responsibility or liability for any personal injury, sickness, death, loss or damage to property occurring during the Delegation or due to any other circumstance whatsoever beyond Agent s control, or due to the act or Delegation of any airline, hotel, restaurant or other party supplying goods or services included in the Delegation. Agent and Sponsor reserve the right to cancel or change the itinerary for the Delegation or to substitute features of the Delegation without notice when reasonably required by the circumstances, and to decline to allow or to continue participation in the Delegation by any person whose health, medical condition or general deportment may impede the operation of the Delegation or detrimentally affect the other Delegation participants. IAF flight is the reasonability of the IAF and the arrangements are not subject to the Warsaw convention or any responsibility of either Mosaic or FIDF. Medical Condition: Each Delegation participant acknowledges that any medical treatment that they may require during the course of this Delegation, and any associated expenses, will be his or her sole financial responsibility and not that of Agent or FIDF. Release and Indemnification: By signing and submitting this Registration, each Delegation participant acknowledges that he or she is aware of the risks inherent in overseas travel and has assumed the risks of participating in the Delegation. These risks include, but are not limited to, personal injury, property damage, or death resulting from accident, illness or acts of terrorism. Each Delegation participant has had an opportunity to read the current United States Department of State s Travel Warning for the Delegation destinations and itinerary and has been apprised of the availability of updated Travel Warning information at http://www.travel.state.gov. He or she will abide by security directives issued by Agent, Sponsor or their representatives during the course of the Delegation. He or she understands that any travel outside of the planned itinerary will be at his or her own risk and Agent and Sponsor will not be responsible for his or her safety or security. Each Delegation participant acknowledges that he or she is primarily responsible for his or her own safety and security while on the Delegation. In consideration of being permitted to participate in 12
the Delegation, each Delegation participant does, for himself or herself and for his or her heirs, executors, administrators and assigns, release, discharge, indemnify and hold harmless Agent and Sponsor and their employees, officers, directors, partners, shareholders, agents and contractors, and their successors and assigns, from and against each and every claim arising during or in connection with the Delegation and by reason of any bodily injuries (including emotional injuries), death or property loss or damage resulting, or alleged to result from, any accident, incident, or occurrence, and whether based on negligence, breach of contract or other cause or principle of law, as a result of his or her participation in the Delegation or any activities related or connected thereto. This Registration form, including this release, contains the entire agreement between the parties and supersedes any other understandings, oral or written, concerning the Delegation. If any portion of this release is held to be invalid, it is agreed that the remaining provisions shall continue in full force and effect. Each Delegation participant affirms that he or she has read this document, understands its content, has had an opportunity to consult with his or her counsel, and recognizes it to be a legal, binding and enforceable contract. The signature of each Delegation participant is required. Participant 1 signature: Date: Participant 2 signature: Date: 13
Important information while traveling with FIDF We recommend purchasing the following insurances: Travel, Baggage and Medical insurance. If you have prescription medications, please make sure to bring enough with you for the trip and carry it in your hand luggage. Many forms of medication that are over the counter in the U.S. are not considered over the counter in Poland and Israel, and some U.S. prescriptions will not be honored by pharmacies for anything not over the counter. If you have food allergies such as Gluten or nuts or any other allergies, please take necessary precautions since we cannot guarantee that the food we provide does not have these components. Travel to Israel & Poland requires passports that are valid for six months from the date of return to the U.S. If you have any citizenship, other than U.S. or Israeli, you are responsible for checking that you can enter Poland and Israel and taking care of the appropriate visas if needed. Proper attire: The average temperature in Poland during the month of May is low 30s to high 50s Fahrenheit. Please make sure to bring warm clothes for this part of the trip, including a raincoat or umbrella. The average temperature in Israel during the month of May is low 60s to high 70s Fahrenheit. Jerusalem tends to be chilly in the evening, so please bring additional layers of clothing. Please bring water-proof walking shoes for both Poland and Israel. Casual and comfortable clothes are recommended during the day. Business causal is recommended for Dinners. As custom in Israel on Memorial Day please wear a white shirt. For the meeting with one of Israel's premier leaders, business attire is required. For Friday night, formal Shabbat clothes are appropriate. Please complete this registration form and send to: Elena Zamudio, the FIDF Delegation Liaison, from Mosaic Tours 6345 Collins Ave. Miami Beach, Fl 33141, Elena@mosaic-tours.com, Fax: (305)865-6522, Tel:(305)865-6991 Deadline for registration is March 16, 2016. Forms received after March 16, will be confirmed according to availability. PLEASE SUBMIT A COPY OF THE PHOTO PAGE OF YOUR PASSPORT WITH THIS APPLICATION Friends of the Israel Defense Forces is a 501 (c)(3) not-for-profit organization. Contributions are tax deductible to the extent permitted by law. 14