REGISTRATION FORM

To the Faculty of Mathematics, Fax number 972-8-9344122

First name:

Family name:

Address:

E-mail:

I am a student (yes/no):

I will participate in the conference dinner (yes/no):

If yes. I participate in the dinner with my partner / accompanying person (yes/no):

I will arrange my own accommodation (yes/no):

If no :

Arrival date (____.____). Departure date (____.____).

Please check one of the following (all prices include breakfast):

( ) a room (single occupancy) at 45 $ or ( ) a shared room at 27.5 $ per person per night (Youth Village).

( ) I share my room with my accompanying person or ( ) with another participant of the workshop, if possible with:

( ) a single or ( ) a double room in the Hotel Basel, Tel-Aviv. (The expected price is 86/106 $)

( ) a single or ( ) a double room in the Hotel Margoa, Rehovot. (The expected price is 58/68 $)

If you stay in Margoa or Basel Hotels please give the following details of your credit card:

Visa/ American Express/ Master Card/ Diners Club (delete as appropriate)

Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiry date: ____.____