Group Request Form

Please take a moment to fill in your information. Fields marked with an asterisk (*) are required.  If you need more space for an answer please use the Special Remarks area.

Your Group Information

First Name:	*
Last Name:	*
Title:
Church Name:	*
# Members:
Mailing Address:	*
City:	*
State:	*
Postal Code:	*
Church Phone:	*
Church Fax:
E-mail:	*
Contact Phone:		Cell      Home     Work
Expected # of Participants:		20 to 30   31 to 40    41 and Up
Departure City & State:
Preferred Travel Dates:
Length of Stay:
Have you or the Church Pastor ever been to Israel?  Yes     No
If yes, how many Times?
		When was the last trip?
		Hotels used in Jerusalem:
		Hotels used in Galilee:
Special Remarks: