REGISTRATION FORM

YES - I am interested in joining the

Missionary Journey to the Land of the Bible!
Costs for Air & Land + Tax:
$3,070 Per Person Sharing a Double Room
$495 Supplement for a Single Room

Led by: Pastor Alan Shelby

November 21 December 1, 2015

Deposit of $250 per person is due by: May 17, 2015

Final Payment is due by: September 9, 2015
(payment plan is available)
TRAVELER INFORMATION
- Please print & include a copy of your passport -

Gratuities are not included.

Suggested amounts per
person per day are:
$6 Guide | $4 Driver | $1
hotel porters & restaurant

1) LAST NAME: _______________________________ FIRST NAME: _________________________________ MIDDLE NAME: _______________________

PASSPORT#: _______________________________ DATE OF ISSUE: _______________________________ EXPIRATION: ___________________________
COUNTRY OF CITIZENSHIP: _________________________________ DATE OF BIRTH: DAY __________ MONTH _____________ YEAR ________________
TRAVEL INSURANCE (7% of the trip cost): YES ________ NO ________ / MEAL REQUEST: VEGETARIAN ________ KOSHER ________ REGULAR _________
2) LAST NAME: _______________________________ FIRST NAME: _________________________________ MIDDLE NAME: _______________________
PASSPORT#: _______________________________ DATE OF ISSUE: _______________________________ EXPIRATION: ___________________________
COUNTRY OF CITIZENSHIP: _________________________________ DATE OF BIRTH: DAY __________ MONTH _____________ YEAR ________________
TRAVEL INSURANCE (7% of the trip cost): YES ________ NO ________ / MEAL REQUEST: VEGETARIAN ________ KOSHER ________ REGULAR _________
MAILING ADDRESS: ________________________________ APT #: ________ CITY: ___________________ STATE: _______ POSTAL CODE: ____________
HOME: ____________________________ CELL: ____________________________ EMAIL: ___________________________________________________
ROOM TYPE (please check one): SINGLE ROOM (+$495) ______ / 1 DOUBLE BED _______ / 2 TWIN BEDS _______ / 3 BEDS (w/ sofa bed or cot) _______
*If you chose 1 Double Bed, 2 Twin Beds or 3 Beds (2 twin beds + sofa bed or cot), please list your roommate(s) name(s) below :
_______________________________________________________________________________________________________
Signature: __________________________________________
1.
2.
3.
4.
5.

Date: __________________________

Please make checks payable to: Midtown Baptist Temple

Form, Check, & Copy of Passport should be mailed to: 3953 Walnut Street, Kansas City, MO 64111
Current airport taxes are subject to change by the airline prior to ticketing
Registration cannot be processed without filling out ALL of the above details
By signing this form you agree to our Terms & Conditions: www.goisraelna.com/terms.htm

For additional information please contact: Ms. Deb Molder | 816-977-6972 | www.lfbi.org | www.mbtkc.org