Please select one or both of the registration options below: Swim from the Heart Rambam Leadership Mission to IsraelClick to Register for Swim From the HeartContact InformationPlease complete for each person participating in the group trip experience.First Name*Last Name*Street Address*AddressCity*State*Zip*Country*Email*Birthday (mm/dd/yyyy)*Cell Number*Home Number*Gender Identity*How do you identify religiously?Emergency Contact Name and Relationship*Emergency Contact Phone Number*Swim DetailsSwim Heat InformationSwimmers have a choice of four different heats. Please register for the Swim by clicking the button at the top of the page. Early registration closes by May 1. Complimentary round-trip transportation will be provided from the Dan Carmel Hotel to the swim meeting location.If swimming, please select your heat option1 km2.6 km4.5 km7.6 kmHelp us Reach our Goals!Fundraising is an essential component toward helping us succeed in finding new treatments and ultimately a cure for Sudden Cardiac Death (SCD) in children and young adults worldwide. Please be a part of this urgent effort and encourage your family and friends to support you in this extraordinary opportunity. American Friends of Rambam will help you reach your goals as this is a team effort!Your Fundraising Goal*$1,800 (suggested minimum goal)$3,600$5,000Another amountDoes your company have a matching gift program?YesNoName of CompanyAdditional InformationWe ask all participants to please provide us with passport details.Full Name on PassportPassport Expiration Date (mm/dd/yyyy) - must be valid through December 2018Passport (or ID) NumberPassport (or ID) NationalityDo you have any medical conditions that may impact your ability to participate in the event? Please explain if necessary.I understand that I should carry traveler's insurance for this trip. I accept that I'm financially responsible for all medical expenses, airfare, hotel accommodations and incidental costs, as well as some meals and transportation to and from the airport.YesDo you have any other questions or concerns?How did you hear about this event?Please provide us with a short (50 words or less) bio to share. This iframe contains the logic required to handle Ajax powered Gravity Forms.