Full Name* First Name Last Name Email* Birth Date DDMMYYYY* 12345678910111213141516171819202122232425262728293031 Day1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Current age* Phone* Whatsapp I am currently in* YGYC Do you drive?* NoYes Upload front of license Upload back of license Emergency Contact name and relationship to you* Emergency Contact phone* Terms* I understand that I will be assisting with coordinating Pesach Seders around Australia and will do my best to ensure the Seders are a complete success.I understand that I must make a Kiddush Hashem at all times throughout the Pesach Shlichus.I understand that while RARA will do the very best to find me a location for Pesach, it is not guaranteed that everyone that signs up will be given a place to go to.I will be on time to all flights. In the event that a flight is missed, I will take responsibility to arrange alternate travel. Comments Submit Should be Empty: This page uses TLS encryption to keep your data secure.