This is where we will get your final information for the trip! Completion of this form reserves your spot and serves as acceptance of your participation on a Perspectives Trip! Confirmation of Passport InformationThis is required for international travel.Full Legal Name*As written on your passport (for confirmation) First Middle Last Sex*As written on your passport (for confirmation)Please Select OneFemaleMaleXDate of Birth* MM slash DD slash YYYY Passport Number*If you are currently not in possession of a valid passport expiring on or after November 22, 2023, OR if your passport's identification contains letters with numbers, please put a zero ("0") here and email [email protected]Passport Expiration Date* MM slash DD slash YYYY Issuer of Passport*United StatesAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwePlease list any Middle-Eastern, African, or Asian countries that have stamps in your passport.* Photo of Passport(Optional though encouraged)Max. file size: 100 MB.Personal InformationPreferred Name*For nametag Gender*For roommate accommodations Pronouns* Dietary AccommodationsPlease check all that apply. Vegetarian Vegan Kosher Gluten Free Peanut Allergy Tree Nut Allergy Dairy Allergy Other (please include at the bottom) Zip Code of Residence* ZIP / Postal Code Please describe any religious observances that we should be aware of during this trip.Please list any preexisting medical conditions that we should be aware of during this trip.Please include all allergies, medications, and relevant medical conditions that may affect your ability to travel for long distances, hike (moderately), walk long distances, stick to a tight schedule, and be focused and engaged in our programming for very long days.Anything else you wish to share?COVID-19 Vaccination InformationAre you currently considered fully-vaccinated?* Yes Photo of Current Vaccination Documentation*Max. file size: 100 MB.Medical Insurance InformationOur program includes limited local medical insurance that covers treatment and medication for conditions that occur during the trip and within Israel only. The policy does not cover pre-existing conditions. To ensure you are fully insured, please include your medical insurance information below. Details on the provided local medical insurance can be found at: https://www.authenticisrael.com/student-leadership-mission/prepare-for-your-trip/Insurance Provider* Insurance Policy Member ID* Photo of Front of Insurance Card(Optional though encouraged)Max. file size: 100 MB.Photo of Back of Insurance Card(Optional though encouraged)Max. file size: 100 MB.Emergency Contact InformationEmergency Contact* First Last Relationship to Participant* Emergency Contact Phone Number*Emergency Contact Email*