
The Many Faces of Israel
Registration Form
Name ____________________________ Age __________ Date of Birth ___/___/_____
Month Day Year
Permanent Address _______________________________
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Name of University _______________________________
Home Phone ________________________
Social Security/Social Insurance Number ___________________
E-mail Address ___________________
Passport Number ___________________ Country of Citizenship _____________
Birthright dates of Activity ___________________
Upon successful completion of the course you will be entitled to get ONE official transcript, which will be sent to the address listed below. A copy will also be sent to your home address.
Please make sure you fill in the exact address the transcript has to go to:
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