JIL ISRAEL TOUR CONGRESS April 20 26, 2014
REGISTRATION FORM
Pastor Mr. Miss Ms.
Passenger Name (as shown in Passport)
______________________________________________________
Date of Birth: ___________________________ Place of Birth:
______________________________
Email: __________________________________ Telephone/Mobile:
_________________________
Home Address:
_______________________________________________________________________
___________________________________________________________________________________
Passport Number: ________________________ Date of Issue:
_______________________________ (Your passport must be valid for up
to six months after the date you enter Israel)
Place of Issue: ____________________________ Date of Expiry:
_____________________________
Nationality: _____________________________ Status:
___________________________________
Name of Company/School:
____________________________________________________________
Office/School Address:
________________________________________________________________
Occupation/Profession: ___________________ Company Tel Number:
_______________________
JIL Chapter/Country:
__________________________________________________________________
Church Pastor: ___________________________ Position Held (if
any): ________________________ IN CASE OF EMERGENCY: Name:
______________________________________________________________________________
Address:
____________________________________________________________________________
Contact Numbers: ________________________ Relationship:
______________________________ FLIGHT DETAILS: Departure (for
Israel): ____________ Flight No. _________________ Date:
_________________
Arrival: _________________________ Flight No. __________________
Date: _________________
TERMS OF PAYMENT: x 50% downpayment on or before January 30,
2015 x 50% full payment on or before February 15, 2015
______________________________________
___________________________________ Signature of Applicant Date
JANET P. TOMAS
74 MERRION RD.BALLSBRIDGE,DUBLIN 4,IRELAND
23 MAY 1970
PHILIPPINES
[email protected]
+353 862109821
PD9829842
08 FEBRUARY 2013
DUBLIN,IRELAND
07 FEBRUARY 2023
IRISH
SINGLE
NANNY
DUBLIN
ROSANNA SESTOSO
JOCELYN BAGSANGTOMAS
,APT.2, 9 SERPENTINE AVE.,BALLSBRIDGE, DUBLIN 4, IRELAND
+353 868508617
FRIEND
SK538
SAT. 18/04
10:20
04:15
SK771
SUN.19/04
JANET P. TOMAS
13 FEB .2015
.
