ATS - Advanced Training School

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A. Personal Information

Enter your name exactly how it appears on your travel documents. Failure to do so may affect your ability to participate.

First Name (as appears on passport)

Middle Name (as appears on passport)

Last Name (as appears on passport)

Preferred name for badge

Email

Agency Name

Title/Rank

Command/Assignment

Birth Date

Gender

MaleFemaleOther

Contact Information

Country

Work Address

City

State

Province

Zip/Postal Code

Preferred contact phone number

Cell Phone Number

Is the cell phone internationally enabled?

YesNo

Have you been to Israel before?

YesNo

When and with whom?

Please specify any food allergies or special dietary needs

Active

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B. Professional Information

*Please attach to your completed registration form the following professional and educational information. You may type your answers or upload them.

a. A chronological listing of the positions you have held in law enforcement, beginning with the most recent
b. Commendations and awards
c. Other relevant professional experience (e.g. military service)
d. Schools attended with degree or diploma earned (Include name of school, location, and dates attended)

TypeUpload

Type answers

a. A chronological listing of the positions you have held in law enforcement, beginning with the most recent

b. Commendations and awards

c. Other relevant professional experience (e.g. military service)

d. Schools attended with degree or diploma earned (Include name of school, location, and dates attended)

School Name 1

Location 1

Degree/Diploma 1

Year Started 1

Year Finished 1

Would you like to enter information for a second school?

YesNo

School 2

School Name 2

Location 2

Degree/Diploma 2

Year Started 2

Year Finished 2

Would you like to enter information for a third school?

YesNo

School 3

School Name 3

Location 3

Degree/Diploma 3

Year Started 3

Year Finished 3

*Upload a PDF

a. A chronological listing of the positions you have held in law enforcement, beginning with the most recent
b. Commendations and awards
c. Other relevant professional experience (e.g. military service)
d. Schools attended with degree or diploma earned (Include name of school, location, and dates attended)

C. Emergency Contact Information

First Name

Last Name

Phone number

Relationship

Email

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D. Cost for participation in LSI

*The Anti-Defamation League (ADL) will be responsible for the cost of airfare to and from Israel, transportation within Israel, hotel accommodations, and meals. Flights to and from Israel will depart from and return to Logan International Airport.

NOT INCLUDED: Cost of Transportation to and from Logan International Airport, charges for items not on ADL's fixed menus, passport, visas, laundry, alcoholic beverages, meals other than those specified, mini bar items, room service, telephone calls, excess baggage charges, personal and baggage insurance, gratuities to local guides for services not included in the program or any other items of a purely personal nature.

I agree

E. Flight Information

Day

Date

Flight

Class

Group

Depart

Arrive

Sun

Dec 2, 2018

LY016

Y

15

Boston: 9:00pm

Tel Aviv: 5:15am

Tues

Dec 11, 2018

LY015

Y

15

Tel Aviv: 12:05pm

Boston: 5:15am

I agree

F. Valid Travel Documents

Participant shall be solely responsible, at Participant's own cost, for obtaining and maintaining a valid passport, having valid health insurance, other insurance coverage, and if required, all necessary visas. If ADL arranges for any services to provide visas, Participant shall be responsible for the cost of all fees, expenses and other amounts associated with such services.

I agree

Passport Information

Passport Issue Date

Enter a date before 3/02/2020

Passport Expiration Date

Enter a date after 6/11/2020

Passport Number

Place of Issue

G. Airline Responsibilities

Airline equipment and routings are subject to change and will not result in any refunds, Fligth delays, changes and cancellations are an inherent risk of any air travel. Participant(s) are subject to ticket terms and tariffs of the airlines, which, when issued, shall be the sole contract between the airline and the Participant(s). Changes or cancellations by an airline for any reason shall be subject to the provisions of the contract of carriage set forth in the passenger tickets, baggage check, and air way bills issued by the airline and its applicable treaties and conventions.

I agree

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H. ADL Modification

Participant hereby authorizes the Anti-Defamation League ("ADL") to alter or modify the itinerary, any arrangements, or any aspects of LSI, at anytime and from time to time. If ADL, in its sole discretion, deems it necessary or advisable, without the prior consent of or notice to the Participant.

I agree

I. Cancellation Policy

Participant shall be responsible, and shall promptly reimburse ADL, for all costs, fees and other expenses incurred by ADL if Participant (i) cancels participation in LSI, (ii) departs earlier or returns later than arranged by ADL, or (iii) changes any travel, hotel, restaurant or other plans associated with LSI. If Participant makes any such changes for any reason, Participant shall also be responsible for all costs, fees and other expenses of alternative transportation, hotel, restaurant and other modifications to LSI arrangements that Participant chooses to make.

I agree

J. Release and Hold Harmless

*In consideration of joining the Program, and by registering for LSI, Participant voluntarily assumes all risks associated with LSI. Participant understands and agrees that ADL and Diesenhaus Unitours Incoming Tourism, and/or Interface Travel Group are intermediaries for other service providers and shall not be liable or responsible to Participant for breach of contract, failure to provide services, or any intentional or careless actions or omissions on the part of any provider of services (such as air carriage, hotel accommodations, ground transportation, meals, tours, cruises, guide services, etc.); and that ADL and Diesenhaus Unitours Incoming Tourism, and/or Interface Travel Group shall not be liable or responsible for any delay, theft, loss, damage, or injury sustained by Participant or Participant’s property arising from any action, inaction, activity, condition or development, normal or abnormal, expected or unexpected, including, without limitation, terrorist activities, social or labor unrest, mechanical or construction difficulties, diseases, local laws, climactic conditions, governmental acts, currency fluctuations, or any modification, curtailment, or cancellation, in whole or in part, of any of the arrangements pertaining to, or services to be provided for, or facilities to be furnished in connection with LSI, or before or after LSI if Participant chooses to extend Participant’s trip, for whatever reason or cause. Participant hereby releases and agrees to hold each of ADL and Diesenhaus Unitours Incoming Tourism, and/or Interface Travel Group harmless from and against any claims Participant may have arising from or relating to any of the foregoing.

Participant acknowledges that Participant is aware of risks associated with LSI, and that Participant is solely and individually responsible for obtaining appropriate insurance coverage against them.

I agree

K. Medical Clearance

*Participant has consulted a physician of Participant’s own choice and has been advised by such physician that Participant is in good health, does not suffer from any physical or mental ailment or disability which requires medical or surgical care or treatment, or which would make travel or participation in LSI hazardous, unwise, unwarranted or a potential source of danger to Participant or others who may participate in LSI or travel, eat or be sheltered with participants in LSI. Participant does not have any information or knowledge as to Participant’s physical or mental condition which Participant has not disclosed to said physician. If Participant is required to take any medications, or if Participant has any special instructions with regard to medications, allergies, etc. Participant is solely responsible for informing ADL of any special needs, but neither ADL nor Diesenhaus Unitours Incoming Tourism, and/or Interface Travel Group shall have any liability or responsibility with respect to such special needs.

In the event of injury, incapacity or illness to Participant, ADL will use its best efforts to contact the emergency contact designee of Participant as soon as possible. However, if ADL is unable to contact the emergency contact designee named, or in case of an emergency, Participant authorizes ADL to consent to medical treatment on behalf of Participant. Participant agrees that it is Participant’s responsibility to pay for medical treatment. Participant hereby assumes all risks associated with or arising from any such medical treatment and agrees to hold each of ADL and Diesenhaus Unitours Incoming Tourism, and/or Interface Travel Group harmless from and against any claims Participant may have arising from or relating to such medical treatment.

I agree

L. Photo/Video Release

Participant hereby grants permission to ADL to photograph, film, audio or videotape, digitally image or otherwise record, reproduce or take any likeness of Participant in any medium, individually or with others, or otherwise in connection with LSI (“Photographs”), and to record, reproduce or transcribe in any medium Participant’s voice, comments, remarks, responses and other written or oral presentations or sound effects made by Participant (“Recordings”), and to use, publish, exhibit, display, copyright, license, sublicense, transfer, edit, disseminate, or in any other way use or exploit (“Publication”) in any language, form or media, whether now or hereafter existing, without prior approval, the Photographs and Recordings, and any parts or excerpts thereof, with or without Participant’s name associated therewith, and with or without the names or likenesses of any fictitious or other real persons, for any purpose whatsoever, including, without limitation, in connection with LSI or otherwise, or the exhibition, theatrically, on film, television, or otherwise, of any production in which same may be used or incorporated, and the advertising, exploiting, or publicizing of any such production, and for any educational, commercial, fundraising, trade and pictorial art, or other purposes. Participant hereby releases and agrees to hold ADL harmless from any claims or liability for damages for libel, slander, invasion of privacy or other claims based on the Publication of any Photographs or Recordings.

I agree

M. Definitions of ADL, Diesenhaus Unitours Incoming Tourism and Interface Travel Group

Any references to ADL, Diesenhaus Unitours Incoming Tourism, and/or Interface Travel Group shall be deemed to include their subsidiaries and affiliates, as applicable, and the officers, commissioners, directors, trustees, employees, agents, successors, licensees, and assigns of all the foregoing, as applicable.

I agree

N. Choice of Venue and Law

Any claim arising under or relating in any manner to this LSI Registration Form, as well as any claim asserted by Participant or anyone claiming a right derived from Participant against ADL or Diesenhaus Unitours Incoming Tourism and/or Interface Travel Group shall be brought only in the Supreme Court of the State of New York, County of New York, or the United States District Court for the Southern District of New York. This LSI Registration Form shall be governed by the laws of the State of New York without giving effect to conflict of laws.

I agree

O. Optional Passenger Travel Protection Insurance Information

*ADL strongly suggests that all participants augment their own health insurance for travel and medical evacuation coverage. Passenger Travel Protection insurance which includes trip interruption, loss of luggage and documents, medical expenses and emergency evacuation and repatriation can be purchased through several independent companies.

www.travelguard.com - 1-800-826-4919

www.travelexinsurance.com - 1-800-228-9792

I have read the above

P. Participant Knowledge of Review and Understanding

You will have a chance to review your answers after hitting the "Submit" button. By clicking "Confirm" on the next page, you agree to the below.

Participant hereby certifies and represents that he or she has carefully read all the terms and conditions and provisions of this LSI Registration Form and fully understands the meaning and effect thereof and, intending to be legally bound, has hereunto set his or her hand on the date of registration submission.

I have read the above