Registration Form

To register for the conference, please fill the form and send it back to:
Itay Arie by email: (itay@logtel.com) or fax (03-9247783)

Name:

Title:
:

Reg.# ).(:

Company:

Zip:

Address:

City:

Cellular:

Email:

Telephone:

Fax:

Name of signatory:

Telephone of signatory:

Choose registration date:

ILS 450
till 28/2/2017

ILS 550
till 30/3/17

ILS 650
till 19/4/17

ILS 780
regular price

Pay by: Check

Transfer Credit Card
Attendees will be entered in a raffle for a valuable prize.
For Credit Card payment, please fill in:
Check one: Visa MasterCard American Express Other, specify: _________________________
Card holder name: _____________________ Card holder address: ______________________________
Card holder phone: _____________________ Card Number: ___________________________________
Expiration date: ___________ (mm/yy) Holders ID card number: ______________________________
Company Stamp

Signature

Terms of Registration:
Due Payment: has to be done before the event.
Terms of canceling participation:
Seven days before the conference: a full price will be charged.
This Registration constitutes your agreement to accept Technology related mails from Logtel.

Please check the box if you disagree.

To register and send payments please write, call or fax Itay Arie: Itay@logtel.com
Tel: 972-3-924 7782, Fax: 03-924 7783 - 32 Shacham St., Petah Tikva, 49170, Israel,
Reg.#(..): 511017089

Schedule and tracks are subject to change.

Should, for any reason, the event be rescheduled or cancelled, the extent of our liability is limited to the return of fees paid to us.

32 Hashacham st. , POB 7765, Petah Tikva 49170 ,Israel | Tel:+972 (3) 9247780 Fax:+972 (3) 9247783 | www.logtel.com