Gender: MF Title: Mr.Mrs.MissDr.Prof. Family name: First name: Home (or work) address: Home & Cellular phone numbers: E-mail:
Nationality: Passport number:(Please check that your passport is valid until June 2020)
I register for: אני ישראלי ומבקש להרשם רק ליום הראשון2.12.2019 השני 3.12.2019 השלישי 4.12.2019 של הכנס , ללא לינה וכלכלה. The conference only And:
I register for the 1 day tour to the dead see and Masada onSunday 1st December 2019Thursday 5th December 2019My accompanying person will join me on the tour and I am paying for him/her.
Accommodation:
Please reserve for me nights in the Ramada Hotel (140 Euro per night)
Please reserve for me nights in the Royal Hotel (90 Euro per night)
Please send me accommodation proposals.
Payment
Please charge my credit card in one paymentPlease divide my payments - Charge my credit card in one half of the payment now, and the second half charge only next month (the second payment will be charge 40 days after the first payment)I am a student and entitled to the student's discount (official certificate is needed).I am paying by a Bank transfer – I'll email you the transfer details within 24 hours.
These are the bank details for the transfer: REGINA TOURS 11, KIRIAT MADA STREET JERUSALEM – ISRAEL BANK LEUMI 208, JAFFA STREET JERUSALEM - ISRAEL BRANCH #904 ACCOUNT #703400/88 SWIFT CODE: LUMIILIT EBAN: IL900109040000070340088
VisaMaster CardAMEX Name of Credit Card Holder: Credit Card Number: Expire Date: 3 back digits of Credit Card:
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