Congregation B'nai Tikvah
Passport to Israel Program

Registration / Deposit Form

Yes, I want to give my child the gift of an Israel experience through the Passport to Israel Program! To start your child's participation in the Passport to Israel Program, return the completed form with a one-time, non-refundable $25 registration fee.

(If your child is already registered, you may use this form for additional deposits.)
For your convenience, please fill in the form on screen then print and mail it with your check.

Name 
Address  
City/State/Zip            Phone 
E-mail 
Child's name 
Social Security #  
 
  I am enclosing a check for $ as the first (or additional) payment
  towards my child's Israel experience.
 
  I am enclosing a check for the $25 one-time registration fee.
  (separate check, please)

Make checks payable to: Congregation B'nai Tikvah, PIP.

    Keith Zimmerman
    7 Stadelman Court
    Kendall Park, NJ 08824