We thank you for your interest in Miles for Smiles. To register please complete this application form. For group or family leaders to create a group please click here General registration information First Name Last Name Address City Zip/Post code State Israel United States England Canada Australia South Africa Mexico Other Home phone Cell/Mobile phone Email address Confirm email address Gender Male Female Date of birth Day Month Year (1930-2010) National identity/ Passport number T-shirt type Long Sleeves Short Sleeves T-shirt size XS S M L XL XXL XXXL Dietary Preferences ‐ can be more than one type No restrictions Lactose intolerant Gluten free Vegetarian Remarks Travelling independently on AKIM Jerusalem’s bus Accommodation I would like to share a room with I would like a single room an extra charge will be payable No preferences ( in this case you will be assigned to a double or triple room ) Emergency Contact Information Full name Phone number Relationship Email address Billing Information Who am I ? Individual part of a Group\Family Individual Registration type and dates Full Trek Participation (8-10 May) Day and Overnight (8-9 May) Day and Overnight (9-10 May) One Day (9 May) One Day (10 May) My team Akim Jerusalem David and Debbie Schottenfels Elisha's barmitzvah family elkus Hassan Family Rashba Family Tobias Family If you have not yet registered your group please click on the link Group registration does not obviate the need to register as an individual as well. Every member of a group must register and in the ‘who am I?’ field, choose an individual part of a group. Registration fee 0₪ Minimum amount according to the registration type - 0$ To continue to secure payment I acknowledge that by participating in the AKIM-Jerusalem Trek (the trek) I commit to raise a specified minimum amount of sponsorship. I acknowledge that AKIM -Jerusalem will not be responsible for any physical harm that might occur to me nor for any damage to or loss of my equipment and property during or following the trek. The trek is a challenging activity and I declare that to the best of my knowledge I am fit to participate. I will provide AKIM Jerusalem with medical supporting documents as required. ?do you have a question\need clarification\help? click here >>
