YZL Israel 2008 Registration

MAKE SURE YOU READ ALL THE INFORMATION ON THE YZL ISRAEL 2008 HOMEPAGE BEFORE YOU REGISTER.

Lastname:

Firstname:

eMail:

Address

City:

State

Zip

Phone

( ) (xxx) xxx-xxxx

Cell

( ) (xxx) xxx-xxxx

Gender

Date of Birth

College/university

Major:

Year of Study

General Info

Have you ever been to Israel?

Yes No

Have you ever participated in a program in Israel?

Yes No

Program	Duration	Year

Are you active on campus?

Yes No

Please specify:

How did you hear about YZL ISRAEL?

Please specify in what capacity and in which framework you would like to contribute? If you already have a project that you would like to propose, please specify

Please elaborate on why you are a suitable candidate for the program?

Do you have a valid passport?

Passport No.:
Date:

Religious affiliation

Please provide us with a short summary of your activities within your community or in collaboration with Hagshama

Additional Comments