Campus Fellowships 2024-Payment Plan Campus Fellowships Poland 2024-Registration Payment Plan Name(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address City State / Province / Region ZIP / Postal Code D.O.B.(Required) MM slash DD slash YYYY Legal Name as it appears on your passport(Required) Passport Number(Required) Passport Nationality(Required) Emergency contact:(Required) Please provide: Name, Phone #, Email and Relationship to you.Parents Contact Information:(Required) Please provide: Name, Phone #, and email for both parents.Do you have any allergies or dietary restrictions? Please list. Do you have any medical conditions or are you taking any medication that YEHUDI should be aware of before traveling? If the answer is "No" please type "No"(Required) What size T-shirt/Sweatshirt can we order for you?(Required) XS S M L XL XXL YEHUDI Fellowships(Required) I agree to the statement belowThe YEHUDI Poland Trip is part of a YEHUDI Fellowship program that includes weekly learning sessions and a pre-trip shabbaton in Miami Beach (scheduled for December 13-14 2024 but subject to change). I understand that by signing up for this trip I am committing to participate in the entire fellowship program. Failure to participate in the entire program could result in disqualification from the Poland trip. Any exceptions must be discussed with your campus YEHUDI educator.Waiver(Required) I have read, understand, and agree to the statement belowI understand that I am participating in this program at my own risk. YEHUDI, its staff and officers are not responsible or liable for and loss of property, injury or , G-d forbid , loss of life that may happen during this program. Olami(Required) I understand and agree to the statement belowYEHUDI receives some funding from Olami. With programs in over 30 countries, Olami and its funding partners sometimes use independent verification firms to assure that programs are attended and impactful. By registering, I understand that I may be contacted by a verification firm for quality control purposesMosaic(Required) I understand and agree to the statement belowOlami is partially funded by Mosaic United. I understand that I may be contacted regarding future Mosaic sponsored -opportunitiesFlights will be booked from either FLL or MIA. If any variation is needed please indicated below. Once flights are booked refunds are solely dependent on the airline refund policy. Any luggage fees are the responsibility of the traveler.(Required) I understand. Please book my flight from FLL or MIA It is absolutly impossible for me to fly from FLL or MIA. Please contact me before booking my flight Pricing(Required)YEHUDI + membership pricing is only available to YEHUDI + members. College student membership is $36 yearly and auto renews on September 1 of each year. Membership allow discounted or free entrance to all YEHUDI events. Membership can be purchased through the link in your acceptance email or the link below. https://yehudi.today/YEHUDI+/college YEHUDI+ Member Price-$999 Full Price-$3,500 Payment Plan Deposit-$333 Payment Plan AuthorizationBy selecting “Payment Plan Deposit” above you are officially committing to the following terms: Your card will be charge $333 today, $333 on November 15 and $333 on December 15. (if you also select travel insurance below, today’s charge will be $433) I agree to the terms of this payment plan. Please bill my card $333 today, $333 on November 15 and $333 in December 15. Travel Insurance(Required)All participants are required to purchase travel insurance before participating in this trip. YEHUDI can purchase travel insurance on your behalf for $100 Please purchase travel insurance for me I understand that I am required to purchase travel insurance for this trip. I will purchase my own travel insurance. YEHUDI should NOT purchase travel insurance on my behalf Total Credit Card