Registration Form

Please complete this form and press submit (note that the connection directly to Israel needs to be made)
Please complete this section accurately, the information you provide will allow us to correspond with you efficiently, and it will also be used for your delegate badge at the Congress.

Identification

Surname    
First name 
Address    
Title      Prof. Dr. Mr. Mrs. Ms.

Department  
Institution 

Mailing Address

No.  Street 
City  State/Province 
Country  Postal Code 
Telephone (Country code/city code/number)  Fax 
E-mail 

Accompanying persons

List only those individuals registering for the Accompanying Persons' Program

Surname  First Name  Title 
Surname  First Name  Title 
Surname  First Name  Title 


Registration Fees

Please check appropriate box/s
                          Until May 15,1996     From May 15,1995
Participant                US $400                US $450
WATOC Member               US $370                US $420
Student                    US $100                US $100
Accompanying Person/s      US $150                US $150 X No. 
Banquet                    US $50                 US $50


Payment


Please indicate amount enclosed: 

Method of Payment
Option 1: Credit Card
      Visa  MasterCard  Diners  American Express
     Card No.  Exp. date month   year
     Cardholder Surname  First Name 

Option 2: Bank Transfer
     Indicate your name and address on the reverse of bank transfer. If payment is made
     for more than one person or by a company please make sure all names are
     indicated and send a copy of the bank transfer. Please make drafts payable to:
     "WATOC '96" and send them to Bank Leumi Le'Israel, Gan Hair Branch,
     Tel-Aviv, Israel. Account number 816-56027/73 Patam.
     Bank charges are the responsibility of the payee and should be paid at 
     source in addition to the registration fees.

Option 3: Cheque made payable to: WATOC 96
     Please send cheque to:
     Secretariat
     WATOC 96
     P.O.Box 50006, Tel-Aviv 61500 Israel

Cancellation policy

Refund of Registration Fees will be made as follows:
Post-marked prior to May 15, 1996 - full refund less US $40 handling fee
Post-marked from May 15 until June 7 - 75% refund
Post-marked after June 8 - 50% refund