Centennial Trip Form

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Be’chol Lashon Travel
Abayudaya Centennial Trip
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Abayudaya Centennial Trip Sign-Up Form

Please fill out the form below to reserve a spot on the trip AND/OR make a contribution to support the Centennial.

Option 1: Join the Abayudaya Centennial Trip to Uganda!

Number of travelers *

1st traveler wishes to attend as a: *

Leader - $10,000 per person, includes one scholarship
Supporter - $6,000 per person
Friend - $3,600 per person

All levels require a $500 deposit to secure spot

Name of 1st traveler *

First

Last

Email of 1st traveler *

Phone of 1st traveler *

1st traveler (Leader) would like the scholarship to be offered to: *

Anyone who needs it
A designated individual

Name of scholarship recipient for 1st traveler (Leader) *

First

Last

2nd traveler wishes to attend as a: *

Leader - $10,000 per person, includes one student/young adult scholarship
Supporter - $6,000 per person
Friend (Student/Young Adult) - $3,600 per person

Name of 2nd traveler *

First

Last

Email of 2nd traveler *

Phone of 2nd traveler *

2nd traveler (Leader) would like the scholarship to be offered to: *

Anyone who needs it
A designated individual

Name of scholarship recipient for 2nd traveler (Leader) *

First

Last

3rd traveler wishes to attend as a: *

Leader - $10,000 per person, includes one student/young adult scholarship
Supporter - $6,000 per person
Friend (Student/Young Adult) - $3,600 per person

Name of 3rd traveler *

First

Last

Email of 3rd traveler *

Phone of 3rd traveler *

3rd traveler (Leader) would like the scholarship to be offered to: *

Anyone who needs it
A designated individual

Name of scholarship recipient for 3rd traveler (Leader) *

First

Last

4th traveler wishes to attend as a: *

Leader - $10,000 per person, includes one student/young adult scholarship
Supporter - $6,000 per person
Friend (Student/Young Adult) - $3,600 per person

Name of 4th traveler *

First

Last

Email of 4th traveler *

Phone of 4th traveler *

4th traveler (Leader) would like the scholarship to be offered to: *

Anyone who needs it
A designated individual

Name of scholarship recipient for 4th traveler (Leader) *

First

Last

Additional Option: Sponsor a student/young adult to attend the Centennial - $3,600 per person

I would like the 1st scholarship to be offered to: *

Anyone who needs it
A designated individual

Name of 1st scholarship recipient *

First

Last

I would like the 2nd scholarship to be offered to: *

Anyone who needs it
A designated individual

Name of 2nd scholarship recipient *

First

Last

Option 2: I am unable to join the trip but would like to support the Centennial by making a tax-deductible donation.

1. I would like to add my name to the Abayudaya Centennial Tree in Stern Synagogue in Nabagoye with a donation of:

Donation amount

2. I would like to sponsor a student/young adult to join the trip ($3,600).

I would like my scholarship donation to be offered to:

Anyone who needs it
A designated individual

Name of scholarship recipient *

First

Last

Additional Information

Name *

First

Last

Email *

Is there anything you would like us to know?

Payment

Total

$ 0.00

Credit Card *

Card

Name on Card

Website

Dates

June 23 – July 2, 2019

Cost

Leader: $10,000

– Includes a student scholarship

Supporter: $6,000

Friend: $3,600

Flights are not included. A limited number of scholarships are available. Students, young adults, Jewish professionals and need-based applicants should contact us for more information.

Deposit: $500 per person

Questions?

Please send us a message or call 415.386.2604.

Abayudaya Centennial Trip Sign-Up Form

Option 1: Join the Abayudaya Centennial Trip to Uganda!

Option 2: I am unable to join the trip but would like to support the Centennial by making a tax-deductible donation.

Additional Information

Payment

Dates

Cost

Questions?

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