Campus Fellowships Rocky Mountains-No FlightCampus Fellowships Rocky Mountain Registration -EitanName(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)Emergency contact:(Required)Please provide: Name, Phone #, Email and Relationship to you.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? XS S M L XL XXLYEHUDI Fellowships(Required) I agree to the statement belowThe YEHUDI Rocky Mountains Trip is part of a YEHUDI Fellowship program that includes weekly learning sessions and a full shabbat experience (scheduled for December 15-16 2023 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 Rocky Mountains 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. 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 flightPlease Charge My card(Required) Price: Total Credit Card