2013 Palestine Summer Encounter Registration

Basic Information

Your Name (exactly as it appears on your passport): *

Nickname (if any):

Your E-mail Address: *

Confirm E-mail Address: *

Gender: *

Male

Female

Your Street Address: *

(Note: please make sure the address you provide is your primary mailing address).

City: *

State:

Zip Code:

Country: *

Date of Birth: *

Citizenship: *

Primary Phone Number: *

	Mobile	Home	Business
Type of Phone

Phone Number: *

Secondary 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.

Religion:

The Palestine Summer Encounter is open to people of all faiths. Answering the above question is optional (you can submit the form without making a selection).

How did you first hear about the Palestine Summer Encounter?: *

Dietary Needs:

Vegetarian

Vegan

Halal

Lactose Intolerant

Please check all that apply.

Other Dietary Needs:

Any allergies or medical conditions we should be aware of? If so please list.:

Travel Plans

Which session are you applying for?: *

Do you have any special travel arrangements? For example, are you arriving a few days late or leaving a few days early? If so, please explain. If not leave blank:

Have you traveled to the Middle East before? If so, where:

Do you need to be picked up at the airport?: *

Yes

(Note: airport pickup comes with an additional fee. Please see the Dates & Cost section of the website for more details).

Is there a friend or family member joining you whom you would prefer to be housed with? If so write their name here:

Housing (Check all that Apply): *

Note: We will try to accommodate participant's preferences, but WE DO NOT GUARANTEE WE CAN ACCOMMODATE ALL REQUESTS. Occasionally a participant prefers to live with an Arabic-only speaking family so that they can really practice their Arabic speaking skills. Participants also sometimes prefer to live with a family of their own faith, or of another faith, for a wide variety of reasons. If you have no preferences please select "no preference."

Volunteer Interests

The following questions will help us match you with an appropriate volunteer opportunity. Listed below are some types of volunteer activities our participants have historically been involved with. Please indicate your interest areas by selecting low interest, mild interest or high interest for each of the categories below. PLEASE REMEMBER THAT NO ONE IS GUARANTEED ANY PARTICULAR TYPE OF VOLUNTEER OPPORTUNITY. We expect all participants to be flexible and open to a variety of possibilities. We will, however, do our best to find a volunteer placement that matches your skills and interests.

Health and Medical Service: *

Oral History / Documentation: *

Teaching English: *

Working with Kids: *

Administrative (research, grant writing, office work, editing documents): *

Website Design: *

Activism (Legal, peacemaking, human rights): *

Media Work (Video, PR/Publicity, Articles, etc.): *

Languages you speak other than English (if any):

Do you have a criminal record?: *

Yes

Do you have any preference as to where you would like to volunteer (a specific type of opportunity)? If so please list:

Personal Reference: *

Please list the name and contact information of a personal reference—preferably a current or former employer or a teacher/professor.

Personal Reference 2: *

Please list the name and contact information of a personal reference—preferably a current or former employer or a teacher/professor.

Work Experience (Please be Detailed): *

Education (List names of schools, degree titles and year of completion or year of completion pending): *

Please tell us a bit about your skills and personal strengths: *

Please tell us a bit about some of your weak areas in terms of work or personal skills: *

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, nor 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 accept that as long as I am a participant in the Palestine Summer Encounter program I will not travel outside the country without the explicit permission of Holy Land Trust.

I understand and accept that Middle East Fellowship and Holy Land Trust reserve the right to use photos taken during the Palestine Summer Encounter with my image and likeness in any official Palestine Summer Encounter promotional material.

I understand that payment for the trip is only partially refundable. Cancellation will result in the loss of the registration fee and flight cost. In addition, if cancellation occurs less than 20 days before the official start date of trip, participants may be liable for a $200 cancellation fee. If cancellation occurs after the start of a program, no refund will be available. If Holy Land Trust or Middle East Fellowship is forced to cancel a trip for any reason, all payments will be refunded to participants with the exception of the registration fee and any flight costs.

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": *

2013 Palestine Summer Encounter Registration

Who We Are

Find us on Facebook

Recent blog posts