general info

REGISTRATION FORM

Participation in the Annual Meeting requires registration by February 15, 2009.

For Meditrans partners, registration fee for the annual meeting (100 EUR per participant) will be deducted from the coming Meditrans payment. Registration is free for the open events (course and symposium).

Personal Information

Please write in English
Fields marked by an * are mandatory.

*Meditrans partner
(or advisor)

Yes
No

*Name:

*Surname
*First

*Title:

Prof. Dr. Mr. Mrs. Ms.

Student:

Yes
No

ID #:

Passport #:

(for Foreign only)*

*Institute/Company:

*Department

*Full Mailing Address:

*City, Postal Code:

*Country:

*Tel:

Fax:

*E-mail:

Car plate #:

for those who want to enter the Weizmann with their car.

* Housing (for Meditrans partners/advisors only)
Please check one of the housing options:

I would like to apply for housing on Campus
(about 55 USD per night; limited number of rooms)

I am willing to share a room:
	Yes - with
	No

Date or arrival (dd/mm/yy)

Date of departure (dd/mm/yy)

I will book a hotel in Tel Aviv
Note that you will need to take a taxi or rent a car to reach Weizmann on Saturday. On workdays, the commute between Tel Aviv and The Weizmann Institute in Rehovot by train is simple (about 25 min ride)

No thanks, no housing is required

Date:

dd/mm/yy