Register for Israel Trip:Aug 24th

	Information
	First Name:
	Last Name:
	Age:
	Phone:
	Email:

	Family Background
	Was your father born Jewish?
	Was your mother born Jewish?
	Personal Information
	Have you participated in Jewish educational programs before?
	If yes, please list which program(s) (include location, month, & year):

	Your current Jewish affiliation:
	List any groups, clubs, or fraternities/sororities you belong to. (Please indicate if you hold a position in any of these organizations and, what your position is):

	Describe your academic interests, hobbies, and extra-curricular activities:

	Briefly explain what you hope to gain from the trip:

	How did you hear about this program?