Mission to Israel Payment form - Lay Leadership February 2024

Lay Leaders Mission to Israel

Monday evening February 19 – Thursday evening February 22

PAYMENT FORM

Cost: $1850.

Mission cost includes hotel (single occupancy), food, transportation and all other trip related costs.
If you room with another participant, the cost will be $1550 and once you confirm, you will each be refunded the $300.
Cost does not include flights.
For the duration of the mission, rooms and meals are only available to mission participants.

Please register using the form below. Please note that you must consent to the waivers below before continuing to the registration.

Consent*
By checking this box, I acknowledge and represent that I am at least eighteen (18) years of age and that I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by agreeing to these terms, and agree to them freely and voluntarily without any inducement.
LIABILITY ACKNOWLEDGEMENT AND WAIVER

By submitting this application, I acknowledge that I have read, understood, and agree:

1. There are certain risks that may occur from participating in this mission to Israel during a War, including but not limited to injury, illness, permanent trauma, kidnapping, or death; and,

2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation; and,

3. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless the Union of Orthodox Jewish Congregations of America (the “Orthodox Union”), their respective officers, directors, trustees, affiliates, agents, employees, independent contractors, consultants, advisors, vendors, volunteers, licensees and assignees (collectively “releasees” and each a “releasee”) from and against every claim, loss, damage and liability or responsibility, including, without limitation, reasonable attorneys’ fees and costs (“liabilities”) arising with respect to any and all injury , disability, death, or loss or damage to person or property, whether arising from the negligence of the releasees or otherwise, to the fullest extent permitted by law.
Media Release*
By checking this box, I acknowledge and represent that I am at least eighteen (18) years of age and that I have read the THE ORTHODOX UNION MEDIA RELEASE, and that I understand it and sign it voluntarily.
ORTHODOX UNION MEDIA RELEASE
From time to time, The Union of Orthodox Jewish Congregations of America, and its programs, employees and agents (together, the “Orthodox Union”) take photographs and videos of individuals, including minors, who attend or participate in Orthodox Union events, programs, and other offerings. The Orthodox Union engages in these activities for purposes relating to the advancement of the religious, spiritual, charitable, and educational goals and objectives of the Orthodox Union, including but not limited to the sharing of photos/videos in newsletters, on our blogs, and on our website and social media pages for the purpose of keeping our members and others informed of the Orthodox Union’s events and other activities. Please complete this form to give us permission to take photos/videos of you and/or your children when you participate in Orthodox Union events or programs and to use those photos/videos in our printed and online publicity:

I hereby authorize the Orthodox Union to take photographs and/or video of me (or my children) when I (or my children) participate at Orthodox Union events or programs. I grant the Orthodox Union full rights to use and share the images resulting from the photographs and/or videos and any reproductions thereof (the “Recording”), in whole or in part, along with my (or my children’s) name, biographical information and quotations for any purpose including fundraising, publicity, advertising, or on social media, all without further obligation or compensation. I hereby waive any right of review or approval regarding the Recording and the Orthodox Union shall have the right to edit or delete the Recording in its sole discretion. I understand that all rights in and to the Recording shall be the Orthodox Union’s sole and absolute property. I understand that if I access the Orthodox Union’s services through a third party platform, product, service, or application (a “Third Party Service”), content and related information generated while accessing OU’s services in this manner may be monitored, captured, and or recorded by the third parties that provide such Third Party Services. I consent to the use and sharing of personal information by any such third party as described in the privacy policy available through the Third Party Service. I release and forever discharge the Orthodox Union from all causes of action, suits, or liability of any kind arising from or in connection with the use or publication of any Recording of me or my children made in connection with my participation in Orthodox Union events. I waive any right of privacy associated with the Recording and I waive any right to compensation related to the use of the Recording.
I HAVE READ THIS AGREEMENT AND AM FULLY AWARE OF ITS CONTENTS, INCLUDING THE RELEASE THAT I HAVE AGREED TO HEREIN.
I warrant that I am at least eighteen years of age (or, if not, that my parent or legal guardian has agreed to the foregoing and signed below) and that I have the full and unrestricted authority to enter into a contract for myself (or, if not, that my parent or legal guardian has agreed to the foregoing and signed below).
If any provision of this agreement is held to be unenforceable, the remainder of it shall continue to be in full force and effect.
This waiver shall remain in effect until such time as I advise the OU otherwise in writing.
Program Registration
Name*
First Last
Legal Name (if different from above)
First Middle Last
Email*
Cell Phone - USA*
WhatsApp number in Israel if different than above
Address (if different than billing address below)
If your home address is the same as you billing address, you may skip this question.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Nationality*
Passport Number*
Passport Expiration*
Please note- this is in the Israeli format of Day, Month Year
DD slash MM slash YYYY
Date of Birth*
Please note- this is in the Israeli format of Day, Month Year
DD slash MM slash YYYY
Day(s) and Date(s) you will be joining the trip
Departure flight information (US to Israel)
Airport Airline & Flight # Departure date & time Arrival date & time

Please use the "add" or + button to include domestic flights if applicable. If you have not yet booked your flight, please email the information to Adeena Mayerfeld at mayerfelda@ou.org as soon as possible.
Return flight information (Israel to US)
Airline and Flight # Departure date Departure time
If you have not yet booked your flight, please email the information to Adeena Mayerfeld at mayerfelda@ou.org as soon as possible.
Current occupation and place of employment, if applicable
Please share any food allergies
Please share your level of fluency in conversational Hebrew so that we can plan our visits accordingly:*
- Fluent
- Mostly fluent
- My receptive Hebrew is stronger than my spoken Hebrew
- My receptive Hebrew and my spoken Hebrew are limited (translator needed)
Communal Involvement
Name of Shul*
Name of Rabbi and Rebbetzin
Lay Leadership/Communal Roles (title, organization and dates)*
Title/Role Organization Dates

Click the "add"/ + button to add up to 5 roles
Please share programs, initiatives, and volunteer work you have been involved with*
Emergency Contact
Emergency contact name
First Last
Relationship
Cell phone
Email
Payment
Mission cost includes hotel (single occupancy), food, transportation and all other trip related costs. If you room with another participant, the cost will be $1550 and once you confirm, you will be refunded the $300. It does not include flights. For the duration of the mission, rooms and meals are only available to mission participants.
Cost - $1850*
Trip cost - $1850
Staff coupon code
Total Cost
$0.00
Billing Address
Street Address City State / Province / Region ZIP / Postal Code Country
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Additional comments
Comments
This field is for validation purposes and should be left unchanged.

Airport	Airline & Flight #	Departure date & time	Arrival date & time

Title/Role	Organization	Dates

Lay Leaders Mission to Israel

Monday evening February 19 – Thursday evening February 22

PAYMENT FORM

Program Registration

Communal Involvement

Emergency Contact

Payment