ED HILL TOURS www.edhilltours.com

760 US Highway One Suite 205 North Palm Beach, FL 33408

phone: 561.624.3200 toll free: 800.780.7801 fax: 561.624.3201

e-mail:

PASSENGER REGISTRATION/APPLICATION

Please fill out this information form as completely as possible and return it to your tour host (Bob Whitney). To avoid mistakes please PRINT or TYPE all answers. You will need a CURRENT VALID PASSPORT to travel outside the USA. If your passport is not valid for SIX months PAST the return date of your tour, please apply for a new one immediately. Citizens of countries other than the USA may need an entry VISA. It is the responsibility of the passenger to obtain the necessary travel documents required to travel. Unavailable passport information requested on this form may be supplied when you receive your passport. This form is required with your deposit even if it is incomplete at the time it is submitted. No medical shots are necessary.

Your Tour Host: GRACE IMMANUEL BIBLE CHURCH Tour dates: June 10-24, 2014

Your Legal Name as it APPEARS ON Your Passport: (please print) Passport name and airline ticket must match exactly.

1.______

The Tour Host/Tour Company will not be responsible for applicable airline fees to change and correct information

Your Name as You PREFER it ON Your Tour Badge: (please print) 2.______

Address: ______E-Mail: ______

City ______State: ______Zip: ______

Telephone: home: (____)______Work: (____)______Cell (____)______

Occupation: ______Marital Status ______Anniversary Date: ______

Passport Number: ______Date of Issue: ______Date of Expiration: ______

Citizen of What Country?______Place of Birth: ______Date of Birth: ______

Name of Roommate: (if known) ______(we cannot guarantee you a roommate)

Do You Request a Single Room at an Additional Cost? ______($1300.00) Do You Smoke? ______

Do You Need Physical Assistance in Any Way? ______Please Specify: ______

Person to Contact in Case of Emergency: ______Telephone: (____) ______

I AM PURCHASING THE AIR & LAND PACKAGE TOUR for ISRAEL & GREECE: ______ISRAEL Only: ______

I AM PURCHASING THE LAND ONLY TOUR for: ISRAEL & GREECE: _____ ISRAELONLY: _____ GREECE ONLY: ______Please supply your airline itinerary if you are purchasing any of the LAND ONLY TOUR packages.

US AIR Frequent Flier Member? ______FF #:______

Deposit: Enclosed with application: $500.00 p/person. Please make check payable to GIBC and write “Israel Deposit” on the memo line. Send application and check to the attention of Bob Whitney, GIBC 17475 Jonathan Drive, Jupiter, FL 33477 Payments due to Ed Hill Tours: Jan.19-$1700.00 p/p / March 10-$1700.00 p/p / May 5, 2014 Final payment/balance is due. Additional payments may be made at any time in any amount.

SIGNATURE: (required for enrollment) ______

Enrollment in the tour constitutes your financial commitment and acceptance of the tour conditions/responsibilities. For your reference, please keep a copy of this form.

The tour host/and or the tour company is not responsible for any mishaps with suppliers or schedule changes that may incur additional passenger expenses. Travel Insurance is recommended.

This information on this form is necessary for the preparation of group travel documents and will be kept confidential.