Bridge Builders 2012-2013 Sign-up Form
Musalaha Young Adults Department
P.O.Box 52110, Jerusalem, 91521
Ronit at 02 672 0376, 0528997334
info@bridgebuilders.no
Participant Information
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First Name
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Last Name
Sex
M
F
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Birth Date
ID number
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Home Phone
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Mobile Phone
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Personal Email Address
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Level of English - Speaking
Low
Good
Very Good
Excellent
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Level of English - Writing
Low
Good
Very Good
Excellent
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Level of English - Understanding
Low
Good
Very Good
Excellent
Address 1
Address 2
City
Zip
Native Language
Arabic
Hebrew
English
Russian
Amharic
Norwegian
Other
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Congregation/Church
Passport Information
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First Name
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Last Name
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Paspport Number
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Birth Date
Nationality
Date of Issue
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Date of Expiry
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Have you ever been denied a visa in the past? If so, why?
Emergency and Medical Information
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In case of emergency, contact
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Emergency contact's address
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Emergency contact's phone
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Relation of Emergency Contact
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Are you allergic to anything?
no
yes, specify
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Do you have any dietary needs?
No
Yes, specify
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Are you on any medication?
No
Yes, specify
Is there anything else
that you would like us to know?
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Short Essay Questions Section
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Briefly describe yourself. What is your occupation? What do you like to do in free time? How are you involved in your church/congregation and/or other ministry?
0/500 words
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If we would like a reference from your pastor or other spiritual leader, who should we contact? Please provide a name, e-mail address, and phone number.
0/500 words
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Why would you like to participate in Bridgebuilders? Why is reconciliation important to you?
0/500 words
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Have you participanted in any Musalaha or other reconciliation events before? If so, give details.
0/500 words
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Please type your name in the box to verify that you understand the following:
1.
If you are accepted into the program and agree to join, you are
committing to BOTH PARTS OF THE TRIP: 3-11/8/2012 in Norway and
22/3-1/4/2013 in Jordan, Israel and West Bank.
2. You will be required to pay NOK 5000 in participation fees for each part, all together 10 000. We suggest you to apply for economic support from your church.
3. If you cancel after the deadline for cancellation, you will be subject to pay NOK 3000
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Please note that by filling this form it does not mean that you are obligated to join the trip, nor does it mean that you will be eligible to go to the trip. Your eligibility will be subject to an interview and a committee decision.
*
Indicates Response Required