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First name (as written in your passport)

Last name (as written in your passport)

Wix email

Passport number

Please upload a copy of your passport

Special food requirements?

Kosher-certified

Vegetarian

Vegan

None

Do you have food allergies?

No

Yes

Would you like to stay in a single or double room?

Single

Double

Number of payment installments

1

2

3

4

I have read and agree with the terms sent to me via email and understand that this donation is made freely, voluntarily and at my own initiative. I consent to a deduction of the selected amount from my paycheck after taxes. I acknowledge that this donation is non-refundable and that the full charge will apply. Additionally, I agree that the information provided may be forwarded to service providers, including but not limited to the March of the Living.

Your Signature

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