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Your Plan

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Personal Details

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medical details

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payment

The AIM student plans are intended for ages 16-29
For other ages please click here..

Please select the plan of your choice*

Gold Plan

$750.00

for one year coverage

$550.00

for Six(6) months coverage

Platinum Plan

$850.00

for one year coverage

$650.00

for Six(6) months coverage

Diamond Plan

$1050.00

for one year coverage

$850.00

for Six(6) months coverage

I am renewing my AIM membership

My AIM ID number was

Start Date*:

* Required field

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Your Plan

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Personal Details

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medical details

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payment

First Name*

Middle Name

Last Name*

Gender*

MaleFemaleOther

Passport*

Social Security/ ID

Birth Date*

Home Address*

City*

State (USA only)

Country*

Zip*

Home Phone*

Mobile

Office Phone

Email*

Present/last school attended*

Program attending in Israel*

Note for Brisk's students: please provide Dira address

Note for Mir's students: please provide Dira address

Note for Other's Yesiva Students: Please specify Yesiva or Address

I have read and agree to the Terms & Conditions of the AIM enrollment application. I agree to pay for all other medical and dental services incurred by the above named registrant, which services are not coveredby the terms and conditions of this agreement and by pressing SUBMIT below, request registration for my child on the AIM plan.*

AIM Gold plan is included for Nishmat students

The school requires the AIM Platinum Plan or Diamond Plan only. Please go back and modify your selection

Magnum Platinum discount applied on check out

upload a copy of your passport

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or send by email to info@aim.co.il

* Required field

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Your Plan

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Personal Details

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medical details

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payment

The applicant has received the following medical care in the last 12 months.

The applicant is presently taking the following medication:

Medication and dosage

Important: The information above does not excuse the necessity of submitting a Medical History form as required.

Upload a Medical History form

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Download a Medical History form

fill it, and send to info@aim.co.il

Insurance At home:

Insurance carrier

Insurance address

Policy number

* Required field

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Gold Plan

Platinum Plan

Diamond Plan

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USA Office

Israel Office