REGISTRATION FORM

Bat-Sheva Seminar on INNATE IMMUNITY
10-15 October 1999

Surname:
First name:
Title:Prof. Dr. Mr. Ms.
ID/passport No:
Nationality:
Institution:
Department:
Mailing address:
e-mail:
Tel:
Fax:
Accommodation:Double room* Single room
My roommate is:
He/she is a participant accompanying person
If no name is indicated, or if the indicated person does not register, the organizers will assign a roommate.
I am: Male Female

Payment

Registration is valid upon receipt of full Registration form and Fees.
Send Check made out to: InTour.
To: Intour - Mrs. Zur, P.O.Box 9095, Ramat-Gan 52190, Israel

PAYMENT IN USD

I wish to register to the Seminar as following:

USD
A. Full Seminar Package
B. Student
C. Daily Seminar Package
D. Daily registration fees
E. Accompanying person
Optional half day tour
Total USD

Date:

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