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Welcome! Get Ready For The Trip Of A Lifetime!

Thank you for your interest in becoming a Birthright Israel madrich(a) (Hebrew for "trip leader").

To begin on this journey, you will need to complete this Trip Staff Registration Form. Without doing so, it will be impossible for your hiring Trip Organizer to assign you to a trip. Some of the information we are requiring will be shared with our travel agent so they can book you on the group flight to and from Israel, while other questions will help us learn more about you and your peers who will be leading our trips. In addition to providing us with a clearer picture of the make-up of our North American madrichim, this data will allow us to better serve you in the future by informing our educational modeling and enabling us to plan future staff training opportunities.

As a madrich(a) on a Birthright Israel trip you will be playing an integral role in the success of the program. We wish you b'hatzlacha (good luck)! And, we look forward to seeing you in Israel acting as a positive Jewish role model for your participants.

Let's get started.

Begin Application

Are you a returning Birthright Israel staff member?

Yes

I have read and accept Birthright Israel's Terms of Service and Privacy Policy.

TRIP STAFF REGISTRATION FORM

About You

First Name

Middle Name

Last Name

Your name above needs to match exactly what appears on your passport. This information will be shared with the airline when booking your round-trip flight to and from Israel. If the names on your passport and ticket do not match, then you will not be allowed to board the flight to Israel.

Preferred Name

Date of Birth (MM/DD/YYYY)

Personal Email

This email will be used in all future correspondence, including communicating your flight assignment details. Please enter a personal email (not a work account), and DO NOT USE an email with an .edu extension.

Secondary/Work Email

Mobile Phone - Country Code

Mobile Phone

Gender

Select the gender that matches what appears on your passport. This is for ticketing purposes.

Pronouns

Please self-describe your pronouns.

Primary Address

Address 1

Address 2

City

Country

State

Province

State/Province

Zip/Postal Code

Emergency Contact

Who should we contact in the case of an emergency?

Please describe this person's relationship to you.

Emergency Contact's First Name

Emergency Contact's Last Name

Emergency Contact's Phone - Country Code

Emergency Contact's Phone

Passport Information

Passport Details

Passport First Name

Passport Middle Name

Passport Last Name

Please confirm that your name above matches exactly what appears on your passport. If you notice anything that needs to be changed, please return to page two of this application and make the appropriate update to your first, middle, or last name.

Passport Number

Passport Expiration Date (MM/DD/YYYY)

Your passport must be valid for at least six months beyond your ticketed (or expected) date of return. If your passport will expire prior to this timeframe, then you will need to obtain a new passport in order to be able to travel.

Country of Issue

Nationality

Passport Documentation

Please upload a picture of your passport (.jpg, .png, .pdf only), and save the file using your passport name plus the word "Passport": (Example: WinnieThePoohPassport.jpg). Ensure that the full page of your passport fits entirely within the frame of your camera (including the bar code at the bottom of the page). Click here for an example.

COVID-19 Status

COVID-19 Vaccination Information

Have you ever tested positive for COVID-19?

YesNo

Please indicate the approximate date of your positive test result (MM/DD/YYYY).

Please share your COVID-19 vaccination status so we can best serve your needs.

Please choose the vaccine type you received.

Please indicate the date you will be fully vaccinated (MM/DD/YYYY).

Please upload your COVID-19 vaccination document (.jpg, .png, or .pdf only), and save the file using your full passport name plus the word "Vaccine": (Example: WinnieThePoohVaccine.png).

Release & Waiver

Staff Waiver and Permission Agreement

I hereby acknowledge that I have read Birthright Israel's Staff Waiver and Permission Agreement and agree to be bound by its terms and conditions including, but not limited to, its Code of Conduct, Sexual Harassment, and Drug and Alcohol Policies.

I Accept

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Welcome! Get Ready For The Trip Of A Lifetime!

Work/Life Experience

Passport Information

COVID-19 Status

Release & Waiver