Cuba Conexión Registration

Name*

First Last

Email*

Cell Phone*

Birthdate*

MM slash DD slash YYYY

T-Shirt Size*

Passport Number*

Issue Country of Passport*

U.S.

Other

Gender as Listed on Passport*

Male

Female

Other Issue Country of Passport*

Full Name as it Appears on Passport*

First Middle Last Suffix

Place of Birth as Stated on Passport*

Passport Expiration Date*

MM slash DD slash YYYY

(Passport must be valid through July 19, 2025 - a minimum of six months beyond the trip date.)

Emergency Contact Name*

Emergency Contact Phone*

Room Request*

I am sharing a room ($3,199)

I request a single occupancy room ($3,499)

I am 22-45 years of age sharing a room ($2,999)

I am 22-45 years of age requesting a single occupancy room ($3,299)

Roommate's Name*

Bed Type*

One Bed

Separate Beds

Meals provided on this mission will be kosher style (no meat or shellfish) with vegetarian options at every meal. Do you have any dietary restrictions (gluten free, dairy free, vegetarian, etc.)?*

Yes

Please list all dietary restrictions.*

Please list all allergies, prescriptions and medical conditions. (N/A if none.)*

Please share any accessibility needs you have to help our team best accommodate your experience on this mission. Our team may contact you to discuss specifics as needed.

Are you registering another participant?*

Yes

Name*

First Last

Email*

Cell Phone*

Birthdate*

MM slash DD slash YYYY

T-Shirt Size*

Passport Number*

Issue Country of Passport*

U.S.

Other

Gender as Listed on Passport*

Male

Female

Other Issue Country of Passport*

Full Name as it Appears on Passport*

First Middle Last Suffix

Place of Birth as Stated on Passport*

Passport Expiration Date*

MM slash DD slash YYYY

(Passport must be valid through July 19, 2025 - a minimum of six months beyond the trip date.)

Emergency Contact Name*

Emergency Contact Phone*

Room Request*

I am sharing a room ($3,199)

I request a single occupancy room ($3,499)

I am 22-45 years of age sharing a room ($2,999)

I am 22-45 years of age requesting a single occupancy room ($3,299)

Roommate's Name*

Bed Type*

One Bed

Separate Beds

Meals provided on this mission will be kosher style (no meat or shellfish) with vegetarian options at every meal. Do you have any dietary restrictions (gluten free, dairy free, vegetarian, etc.)?*

Yes

Please list all dietary restrictions.*

Please list all allergies, prescriptions and medical conditions. (N/A if none.)*

Please share any accessibility needs you have to help our team best accommodate your experience on this mission. Our team may contact you to discuss specifics as needed.

Agreements

Photo Release and Liability Agreement*

By registering for this event, I (we) agree that my (our) picture and/or video may be taken and potentially used in Jewish Federation marketing material and social media.

Yes, I (we) agree.

Campaign Participation Agreement*

I (We) understand that participation in this Mission requires a minimum commitment of $1,800 each year to the 2025 and 2026 Federation Community Campaigns.

Yes, I (we) agree.

Trip and Health Insurance is Required*

I (We) understand it is expressly required that I review my personal insurance coverage needs with my insurance advisors to determine if additional travel insurance is required providing for reimbursement for trip delay, missed connections, sickness and accident, medical expenses, lost baggage, personal effects, baggage delay, etc.

Yes, I (we) agree.

Payment Information

When you submit your registration, you will be redirected to a payment form. A $500 non-refundable deposit is due now to secure your registration. You are free to make a larger payment up to the total amount due at this time, if you prefer.

CANCELLATION POLICY

50% Refund (minus deposit): Cancel on or before Sunday, Nov. 10, 2024
35% Refund (minus deposit): Cancel on or before Friday, Dec. 20, 2024
No Refund: Cancellations after Friday, Dec. 20, 2024

Thank you.

Your Total

Phone

This field is for validation purposes and should be left unchanged.

Support Civilian Victims of the Terror Attack in Israel

Cuba Conexión Mission Registration

Agreements

Payment Information

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