Registration Form Tour Name: Tour Israel With
Every Home for Christ Tour Leader: Eric Leach Title (circle Title) Mr, Ms, Mrs, Miss, Dr, Prof, Rev Firstname................................................... Surname..................................................... Date of Birth............................................... Preferred Christian Name..........................
Passport Information Passport No................................................ Name (EXACTLY as it appears in your passport) .................................................................... Passport Country....................................... Passport Expiry.......................................... Place of Issue............................................. Please forward a photocopy of your passport
Postal Address.......................................... ................................................................... ................................................................... State........................................................... Postcode....................................................
Special Requests
Home Phone.............................................. Work Phone............................................... Mobile Number........................................... Email..........................................................
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Frequent Flyer Account No................................................ Airline.........................................................
Rooming (Please Circle selection) Single Double Twin Sharing with...............................................
Emergency Contact Person’s Name........................................... Daytime Phone........................................... A/H Phone..................................................
Seating (forward,rear,wing,bulkhead,window,aisle) .................................................................... Special Meal (eg. vegan, lacto-ovo vegetarian, lowfat, gluten free, allergies etc.)
Deposit Information Please Tick: I will be attending the Israel, Jordan & Egypt Tour I will be attending the Israel Tour Only $400 deposit for each person is required to secure a place on the tour. Deposit amount enclosed $........................ Pay By Cheque or Money Order (Please make out to Every Home for Christ ) Pay By Credit Card: AMEX Master Card
Diners Card Visa
Credit Card Holder Name .................................................................... Signature..................................................... Credit Card No Exp Date......................................................
Australia: PO Box 168 Penshurst NSW 2222 Telephone: (02) 9570 8211 Facsimile: (02) 9570 4738 New Zealand: PO Box 31-260 Milford North Shore City 0741 Telephone: Free call 0800 900 200 Facsimile: 0061 2 9570 4738
www.everyhome.org.au
ehc@everyhome.org.au