עברית

 
 

Ein Gedi Workshop
Eurocheque payment
form for Registration & Accommodation

Please, before you submit this form, print it (after details are filling), attach it to your Eurocheques and mail it to:
Israeli Institute of Group Analysis
20 D. Yelin st. Tel Aviv, 62964 ISRAEL

The payment can be paid in installments according to the date of registrations as followed:
Till 1/11/08    - 6 Checques
Till 31/12/08 -  4 Checques
Till 28/02/09 -  2 Checques

  Fields marked with * are mandatory
*  First name:
*  Surename::
*  Title:
*  Street:
*  City:
*  Country:
  State:
  Zip Code:
*  E-mail:

I would like to stay in

*  Ein Gedi room type:
           
*  In:
        
*  For:
        
*  From: 06.02.2012
*  Till: 06.02.2012

Don't forget to print this form before you submit it.

 

*  Identification Code Identification Code