Christ at the Checkpoint Student Delegation — Registration

Basic Information

Your Name: *

Your E-mail Address: *

Confirm E-mail Address: *

Gender: *

Male

Female

School/University Where Currently Enrolled (if applicable):

Your Street Address: *

City:

State:

Country: *

Date of Birth: *

Citizenship: *

Primary Phone Number:

	Mobile	Home	Business
Type of Phone

Phone Number: *

Emergency Contact Information: *

Please provide information on who should be contacted in case of emergency, please include their name, their phone number and any other relevant info.

Would you like us to arrange a driver to pick you up from the airport for an additional $100 fee?: *

Yes

Church/Organization Affiliation:

How did you hear about the conference?:

Are you a vegetarian?: *

Yes

Do you have specific medical needs or mobility problems?: *

Yes

If yes, please explain.:

Would you like us to keep you informed about updates to this program and others by signing up for our free, low volume e-mail newsletter?: *

Yes

Please tell us (briefly) about your motivations for joining this delegation—what you hope to learn or accomplish as a participant or why it appeals to you.: *

Other Comments

Anything else we should know? Comments? Requests?:

Liability/Legal

I confirm that all information I have provided in the registration process is correct to the best of my knowledge.

I appreciate the risks inherent to travel within the Middle East, including the risk of discomfort, delay, inconvenience and injury. I accept that neither Middle East Fellowship nor Holy Land Trust will be liable for loss of or damage to property, or for injury or death however arising.

I agree to follow all rules and guidelines set by Middle East Fellowship and Holy Land Trust staff.

I understand that Middle East Fellowship and Holy Land Trust reserve the right to deny any application form submitted.

I accept that Middle East Fellowship, Holy Land Trust and its agents reserve the right to remove individuals from the program whose behavior, in the sole opinion of our staff, is deemed culturally insensitive, inappropriate or beyond the guidelines set for program participants.

I understand and accept that all program fees submitted are only refundable if the cancellation occurs 30 days before the official start of the trip, and that any refunds will not include any transaction fees incurred. Less than 30 days prior to the start of the program a cancellation fee may apply to any refunds offered. No refunds will be available after the program start date.

If you agree to all of the terms and conditions listed above, please type the words "I agree" in the field below. Your application will not be considered complete until you have agreed to the terms and conditions above.

If you agree with the above, please type "I agree": *

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Christ at the Checkpoint Student Delegation — Registration

Christ at the Checkpoint Student Delegation March 2nd-12th, 2012

Christ at the Checkpoint Conference

Featured Speaker: Gary Burge

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Featured Speaker: Alex Awad

Featured Speaker: Ben White

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