| Booking form

Contact Information

Contact
Information
Personal
Information
Emergency
Contact
Information
Health,
Welfare and
Diet
Payment
Options

First Name (as appears in passport)*

Middle Name (as appears in passport)

Last Name (as appears in passport)*

Gender*

Male Female

You will be given a name badge for the duration of the trip. What first names should appear?*

Email Address *

Home Phone Number

Mobile Number *

Address Street Address *

Address Line 2

City *

County / State / Region *

Country

Date of Birth*

Passposrt Expiry Date*

Where is your passport from? *

If you are flying from somewhere other than London please state where your first choice would be:

Name/s of person/s you would like to share a room with (Rooms are twins and triples)

Emergency Contact #1

Last Name*

First Name*

Emergency Phone Number*

Emergency Email*

Relation To You*

Emergency Contact #2

Last Name*

First Name*

Emergency Phone Number*

Emergency Email*

Relation To You*

Do you have any food allergies or other allergies? (Please list in full)

Do you have any dietary concerns? (Please list in full)

Do you suffer from any medical conditions? (Please list in full)

Please list any medications that you take.

A visit to Poland can be a psychologically challenging experience; have you any history of mental or psychological illness of any kind?

Please provide us with any further information particularly if you have been on an organised intense programme before e.g. Birthright

If you would like to have a conversation with us about the intensity of the trip, please indicate here

Yes No

In the last 5 years have you suffered any recurring illnesses or required extended hospitalisation?

Please provide details of any other significant conditions we should be aware of e.g. eating disorders, severe phobias etc.

NB. If you are planning on joining the trip and are pregnant please get in touch directly to discuss insurance.

Please ensure you have disclosed everything relating to your issues and that you have full medical insurance.

How did you hear about March of the Living 2019?

Payment Options

Students

A £50 non-refundable deposit is required to secure your place then a further £300 for the cost of the trip is required by February to fully process your application.

Young Adults

A £100 non-refundable deposit is required to secure your place then a further £350 for the cost of the triwp is required by February to fully process your application.

Adults

A £200 non-refundable deposit is required to secure your place plus a further £1,050 for the cost of the trip is required by February to fully process your application.

Payment for your trip can be made either by sending a cheque made payable to March of the Living UK in an envelope addressed to March of the Living UK 2019, Central House, 1 Ballards Lane,London N3 1LQ

Or by bank transfer to:
Bank Metrobank
Sort Code 23-05-80
Account Number 13321124
Account Gerald Edelman client account re: March of the Living

We cannot process your application without full payment for the trip.

By ticking this box, I accept the Term and Conditions

Name of Participant*

Date*

This statement tells you about the data processing practices of March of the Living UK. We collect and retain only relevant personal information about you which is used exclusively for our fundraising and promotional purposes and in the pursuance of our charitable objectives. We do not share your information with any other charities or external third parties. We are very mindful of the sensitivity of your personal information and we have taken all reasonable steps to ensure that your information is: accurate and up-to-date, not excessive, properly protected and held in the strictest confidence. If wish your details to be removed from our database please email us at info@marchoftheliving.org.uk