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.) 


[  ]   I am enclosing a check for the $25 one-time registration fee.
                (separate check, please)

[  ]   I am enclosing a check for $________ as the first (or additional)
       payment towards my child's Israel experience.


Child's Name _______________________      Current school grade _____


Child's Social Security Number ______-_____-________


Address ____________________________________________________________

        ____________________________________________________________


Parent or Guardian ______________________________________


Phone (_____) _____-________   E-mail__________________________________

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

    Keith Zimmerman
    7 Stadelman Court
    Kendall Park, NJ 08824