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Gender: MF Title: Mr.Mrs.MissDr.Prof. Family name: First name: Home (or work) address: Country Home & Cellular phone numbers: E-mail:
I am registering for: The conference
Accommodation: Please send me accommodation proposals in Tel-Aviv
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 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 ISRAEL LTD BANK HAPOALIM. GOLDA MEIR STR 801, JERUSALEM, ISRAEL BRANCH: #538 ACCOUNT: #444770 SWIFT CODE: POALILIT EBAN: IL340125380000000444770
VisaMaster CardAMEX Name of Credit Card Holder: Credit Card Number: Expire Date: 3 back digits of Credit Card: