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 January 2020)
I register for: The conference only
+ 1 Day Jerusalem tour before the conference (Sunday 21 July) 110$+ 1 Day Jerusalem tour after the conference (Thursday 25 July) 110$+ 1 Day tour to the Dead Sea and Masada (Friday 26 July) 120$+ 2DAY tour after the conference (Jerusalem + Dead Sea and Masada. Thursday- Friday 25-26 July. without hotel accommodation 220$2DAY tour after the conference (Jerusalem + Dead Sea and Masada.25-26 July) including hotel accommodation in Jerusalem for the night of the 25th July) 390$My accompanying person will join me on the tour and I am paying for him/her.
Accommodation: Please send me accommodation proposals.
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:
Use this form here – or contact us directly by mail: [email protected]
Your Name (required)
Your Email (required)
[honeypot honeypot-704 validautocomplete:true move-inline-css:true nomessage:true]