Participation form - Travel2Palestine

Your email *

Prefix *

EG Ms/Mrs/Mr/Mx/Dr/Cllr

Your name *

First

Last

Suffix

EG AM/MP/MSP

Your mobile number *

Your landline number

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Security and emergency information

Does your name appear differently in your passport? *

Yes
No

Write your name exactly as it appears in your passport

Name of emergency contact *

First

Last

Emergency contact phone number *

Preferably mobile number or choice of numbers

Your relationship with your emergency contact *

EG mother/daughter/friend/father etc

Which state issued your passport? *

UK
Other

If other state which:

Passport number *

Date of birth

ddmmyyyy

Passport expiry date *

ddmmyyyy

What countries (if any) do you have stamps from?

Please give us the names of countries you have stamps outside the US, Australia, New Zealand, Canada and Europe.

Have you travelled to Israel and Palestine before?

Israel
the West Bank
Gaza

Please tick all that apply

Have you ever been refused entry to Israel? *

Yes
No

Do you have any family and/or friends in Israel/Palestine?

Health and diet

Dietary requirements

Other dietary requirements

Any known allergies or special information we should know in an emergency?

Yes
No

Please provide health / allergy information we should know about it in advance

This should include allergies, including allergies to medicine.

Do you have a disability or any existing health conditions that you feel could affect your participation during the visit?

Yes
no

We can then further discuss adaptations needed.

Please provide details

Getting ready for the visit!

This is so we can make sure we do as much as possible on the visit to meet your needs and wishes

Do you have particular people or groups you'd like to meet

Yes
No

Please provide details

Do you speak Arabic or Hebrew?

Arabic
Hebrew

Are you a member of a political party?

Yes
No

Please tell us which Party you are a member of

Other party

If you are a member of an international party or another UK political party

Are you happy for us to share your email address with others on the visit?

Yes
No
Unsure

This is so that you can contact each other, and get to know each other before the visit

Terms and conditions *

I have read and agree to the Terms of Service

Please open in a new tab or browser to read

GDPR Agreement *

I consent to having this website store my submitted information so Travel2Palestine can prepare for my visit

Security and emergency information

Health and diet

Getting ready for the visit!

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