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Full name :
Institution :
Address :
Telephone :   Mobile :
I hereby confirm my participation in conference:

with contribution :      

without contribution :  

Title of the presentation/contribution:
Do you want to book accommodation? (please tick) Accommodation:

from 18. to 19. February 2017 :- Yes      No   (not for local participants)

from 19 to 20. February 2017 :- Yes      No  

from 20. to 21. February 2017 :- Yes      No   (not for local participants)

Room :

single      double  

1 night Accommodation will be provided for local participants with contribution Please fill the date and time and place of your arrival to the Palestinian Territories if you need assistance with travel to hotel (For International Participants).
I need assistance with arrival from:
Tel Aviv airport: 
King Hussein Bridge: 
Sheikh Hussein Bridge: 

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