YEHUDI YP Fellowships: Costa Rica 2023-Registration YP Costa Rica Registration 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) 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 XXL YEHUDI Fellowships(Required) I agree to the statement belowThe YEHUDI Costa Rica Trip is part of a YEHUDI Fellowship program that includes weekly learning sessions and a full shabbat experience (scheduled for December 1-2 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 Costa Rica trip. Any exceptions must be discussed with Rabbi Sachi Rubin.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(Required) I understand that the price below does not include flights. I am responsible to book my own flights.Please plan to arrive before 3:00 pm on December 25 and to depart after 3pm December 31. Otherwise, you may be responsible for your own transportation to meet the group in Costa Rica.Please Charge My card(Required) Price: Total Credit Card