| Church/Organization | |
| Preferred First Name | |
| Street Address | C/O Bridges for Peace |
| City | Jerusalem |
| Postal/Zip Code | 91010 |
| Mobile Phone | |
| Home Phone |
| Membership Credential | |
| Mailing List | Yes |
| Marital Status | Married |
| Length of Marriage | 30 years, 10 months ago |
