Adult Program - Registration Form

Please fill in the form below. If you haven't already please make sure you read the following information.

Personal Details

Date of Birth:

Emergency Contact

General Information

Have you ever visited / lived in Poland?:
Have you ever visited / lived in Israel?:
If you are planning/would like to visit your shtetl (family town) while in Poland, please provide the name of the city/town/village that your family member came from.
Note: AMOTL cannot guarantee that such visits will be possible within the timeframe of the Program, however if it happens to be en route and if possible and feasible, we will endeavour to include this in the program’s itinerary, without causing too much disruption to the Program. Participants therefore will be responsible for making their own arrangements if they want to conduct such a visit and need to discuss this with the AMOTL organisers well in advance of your departure from Australia.
I have read, understood and agree to the Terms and Conditions outlined separately.: