ACCOMMODATION FORM
Please print, fill and send the
form by Fax to +972-3-6967990
or you can save the text file,
fill it electronically and
send it by e-mail to
Participant Information
=======================
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Family Name: | First Name: |Title:
| |
-----------------------------+-----------------------------+-------------------
Company:
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Mailing Address:
----------------------------------------------------------+--------------------
City & State: | Country: |Zip Code:
| |
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Phone: |Fax: |E-Mail:
| |
Include country and |Include country and |
area codes |area codes |
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Accommodation Information (Dan Panorama Hotel - tel Aviv):
==========================================================
------------+-----------+----------+--------+---------+-----------+-----------+
Type of Room|Category of|Rate (US$)| # of | # of | Total | Deposit |
| Room(b) |per Night | Rooms |Nights(c)| Due | (d) |
------------+-----------+----------+--------+---------+-----------+-----------+
| Standard | $139.00 | | | | |
Single +-----------+----------+--------+---------+-----------+-----------+
| Deluxe | $156.00 | | | | |
Occupancy +-----------+----------+--------+---------+-----------+-----------+
| Executive | $166.00 | | | | |
------------+-----------+----------+--------+---------+-----------+-----------+
| Standard | $157.50 | | | | |
Double +-----------+----------+--------+---------+-----------+-----------+
| Deluxe | $174.50 | | | | |
Occupancy +-----------+----------+--------+---------+-----------+-----------+
(a) | Executive | $184.50 | | | | |
------------+-----------+----------+--------+---------+-----------+-----------+
+--+ +--+
(a) | | Double bed | | Two twin beds; I'll share my room with:
+--+ +--+
+--+
(b) Special requests: | | Non Smoking; Other (please specify):
+--+ (upon avail.)
(c) Check-In date: ____________________ Check-Out date: ____________________
(d) Deposit: Rate of one night of the requested accommodation
Payment Information
===================
+--+
| | I issued a company check (personal checks are not accepted) in USD
+--+ Payable to Eshet and I sent it by snail-mail to
ESHET, 8 Nahalat Yitzhak Street, Tel-Aviv 67442, ISRAEL.
+--+
| | I made a bank transfer in USD to ESHET's bank account:
+--+ ESHET INCOMING, C/O BANK LEUMI
BRANCH 654, ACCOUNT NO. 310800/94, TEL-AVIV (ISRAEL)
+--+
| | Please debit my credit card below:
+--+
------------+---+-----------+---+-----------+---+-----------+---+-----------+
Type of Card| | Visa | | Diners | | MasterCard| | AMEX |
------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
Credit Card | | | | | | | | | | | | | | | | |
Number | | | | | | | | | | | | | | | | |
------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+---+
Expiration | | Name as | |
Date | | on Card | |
------------+-------------------+-----------+-------------------------------+
Important information:
Cancellation and refund
policy:
Last updated 9/16/99