Print Version
You can also download a copy of the registration form and FAX or Mail it to:
MITTELPUNKT GMBH, Gentzstr. 4, D-80796 Munich
Fax (Munich): (+ 49) 89 44 45 43 55
Fax (Zurich) (+ 41) 44 262 14 88
Fax (Israel): (+ 972) 3 7610 790
Registration Form
Registration
Mr / Mrs / Ms:
Surname:
First Name:
Mailing Address:
City:
Zip Code:
Country:
Email:
Tel:
Fax:
Mobile:
Sharing room with:
Mr / Mrs / Ms:
Surname:
First Name:
Country:
Registration and Accommodation Package:
Package includes 3 nights’ accommodation, kosher meals, activities and events as described in the program.
All prices are in Euros.
Registration received until February 16, 2006
Per person in double room € 495
Double room (2 persons) € 990
Single room € 645
Registration received from February 17, 2006
Per person in double room € 550
Double room (2 persons) € 1100
Single room € 710
Payment details:
CREDIT CARD
We accept Visa, MasterCard and American Express
Visa
MasterCard
AMEX
Card Number:
Valid until:
/
Name on Card:
BANK TRANSFER
Please make drafts payable to:
Mittelpunkt GmbH
Leumi, Migdaley Aviv, Tel Aviv, Israel
Account: 150 500/ 28 Branch 812
Swift: LULIILITXXX
Reference:
55+ Prague 2005
PLEASE
make a copy of your bank transfer, ensure that your name is clearly visible on it, and send it to us together with your registration form.
Cancellation Policy:
All cancellations must be faxed, electronically mailed or post-marked. Refund of registration fees is as follows:
Postmarked until and including February 16, 2006 – full refund (less € 50 handling fee).
Postmarked from February 17, 2006 – 50% refund.
No refund on cancellations after March 1, 2006 – no refund
Authentication:
I hereby authorize Mittelpunkt GmbH to charge my credit card as stipulated above.
Registration
Form
