Registration for Mission to Washington

Mission Date: Wednesday, May 17th, 2017

If you reside outside of the NY-NJ-CT tri-state area or are a member of the clergy/rabbinate, special rates may apply. Special College Student rates may also apply. Please call 201-788-5133 for more information.

Please Note: Last day for a refund is 30 days before Mission Date



Personal Information
Fields marked with an (*) are required.

* Title
* First Name
* Last Name
* Address
* City
* State
* Zip Code
* Email
* Verify email
* Cell Phone - -
We require a cell phone # so that we can contact you on the day of the Mission.
* Home Phone - -
Work Phone - -
Preferred Contact Phone
Please Select if Applicable: Student
(Occupation and employment info required in order to comply with Federal campaign law)
* Occupation
Ex: Attorney; Homemaker
Self Employed
* Employer
Ex: Verizon
Mission Registration
* Bus Location:
* Registrant Type
Which Members of Congress do you have significant relationships with?
Please list them:
Type:
Last name:
State:
Affiliation:
(+) Add Member of Congress Connection
List former residence, family, or business ties outside the tri-state area (aids meeting placement):
I would like to be grouped and bused with the following people if possible:
Please list:
Vegetarian?
Synagogue, religious or community center affiliation (optional):
Support NORPAC

The Mission fee is a subsidized rate. If you would like to help support the success of the trip and other activities strengthening the US-Israel relationship, please choose a Membership category from the list.
Contributions to NORPAC are not tax deductible.
Federal law requires us to use our best effort to collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in a calendar year. Thank you for your cooperation.

Membership Categories
$10,000 President's Minyan
$5,000 Presidential Cabinet
$2,500 Senatorial Cabinet
$1,800 Congressional Cabinet
$1,000 Consulting Cabinet
$500 Benefactor
$250 Patron
$100 Member
Other Amount $
Not at this time.

*Please confirm that the following statements are true and accurate:

  • I am not a foreign national who lacks permanent residence in the United States.
  • I am not a federal contractor.
  • This contribution is made from my own funds, and not those of another.
  • This contribution is not made from the general treasury funds of a corporation, labor organization, or national bank.
  • This contribution is made on a personal credit card or debit card for which I have the legal obligation to pay and is not made either by a corporate or business entity card or on the card of another person.
  • I am at least 18 years old.

Please call 201-788-5133 for assistance if you have any issues with registration.