The 2nd International Conference in Palliative Care – “Palliative Care in Different Cultures” March 19-22, 2008, Herods Hotel,

REGISTRATION FORM

Please PRINT in BLOCK LETTERS and AIRMAIL or FAX to: OFAKIM Travel and Tours (Mrs. Dorit Heldenberg) 82 Menachem Begin St. , Israel 67138; Tel: +972-3-761-0805; Fax: +972-3-761-0799, E-mail: [email protected]

Please complete this section accurately. The information you provide will allow us to correspond with you efficiently.

A. PARTICIPANT (Please TYPE or PRINT IN BLOCK LETTERS) Surname Firstname Title

Mailing Address: □ Office □ Residence Street ______Suite/ Apt. ______City______State/Province ______Postal code ______Country ______Telephone (office hours) Country code/ City code/ number: ______Fax country code/city code/number: ______E-mail address: ______@______

B. CONFERENCE REGISTRATION (Please fill in the relevant details)

Until After January 15, 2008 January 15, 2008 Western Europe, The conference registration USA, Canada, fee includes participation in  450$  500$ the scientific program, coffee EAPC members breaks and lunch throughout the conference days, Eastern Europe, Welcome Cocktail Reception South Africa,  250$  300$ for the participant and Non companion and Gala Dinner EAPC members  500$  550 $ for the registered participant only.

Total Registration:

C. COMPANION PARTICIPATION (Please fill in the relevant)

Total Fee:

_____ X 45 pax Welcome Cocktail Reception USD

Gala Dinner per person _____ X 85 pax USD

* Participation at the Gala/ Cocktail will be allowed to 12 years old and up

D. ACCOMMODATION

Herods Hotel, Eilat, Israel - Conference Hotel (5-Star Deluxe) The hotel rates refer to 1 night of the conference on a BB Basis (March 19-22, 2008)

Please make sure you mark the requested room -

Hotel Name Room type Per Night Package for 3 nights Herods Single room  205 $  615 $ 5* Deluxe Hotel Double room  227 $  680 $

Triple room  320 $  960 $

Double room + 1 Child  255 $  Extra for 2 children in a  204 $  separate room Extra for 3 children in a  232 $  separate room

Dan Panorama Single room  134 $  400 $ 5* Hotel Double room  148 $  440 $

Triple room  196 $  588 $

Double room + 1 Child  175 $  525 $

Extra payment for 2 children  70 $  210 $ in the parents room Extra payment for 2 children  101 $  303 $ in a separate room Extra payment for 3 children  140 $  420 $ in a separate room

Astral Village Single room  127 $  381 $ 4* Hotel Double room  149 $  447 $

Triple room  201 $  603 $

Double room + 1 Child  180 $  540 $ Extra payment for 2 children  82 $  246 $ in the parents room Extra payment for 2 children  108 $  324 $ in a separate room Extra payment for 3 children  144 $  432 $ in a separate room

Americana 2* Hotel Single room  78 $  234 $

Double room  98 $  294 $

Hotel Name Room type Per Night Package for 3 nights

Americana 2* Hotel Triple room  137 $  411$

Double room + 1 Child  122 $  366 $ Extra payment for 2 children  147 $  441 $ in the parents room

 The Price for the Astral Village only is on a HB basis (two meals for a day)  Please note that the accommodation for 3 people in one room in the Astral Village is a little bit crowded, we recommend for three people to stay in 2 rooms.  Please note, check out is not possible on Friday.  Child, age 2- 12.

Type of room ______Check in ______Check out ______Total nights ______I will share my accommodation with: Surname ______First Name______Comment / other requests ______

Total Accommodation:

USD E. DOMESTIC GROUP FLIGHTS

ISRAIR AIRLINE: Route Time Flight Number Price

 9:45 53 $ per person (adult) per one Sde-Dov - Eilat March 18th,  12:00 way 2008  9:00 50 $ per person (adult) per one Ben-Gurion - Eilat Tuesday  16:30 way (To Eilat) 88 $ per person (adult) per one - Eilat  In checking way  8:10 53 $ per person (adult) per one th Sde-Dov - Eilat March 19 ,  9:45 way 2008  9:00 50 $ per person (adult) per one Ben-Gurion - Eilat Wednesday  12:15 way (From Eilat) 88 $ per person (adult) per one Haifa - Eilat  In checking way March 22nd,  18:30 76 $ per person (adult) per one Eilat – Sde-Dov 2008  20:35 way Saturday  18:00 70 $ per person (adult) per one Eilat - Ben-Gurion (From Eilat)  21:25 way 91 $ per person (adult) per one Eilat - Haifa  In checking way

The Price for a child – 53 $ The price for an infant – 12 $

ARKIA Route Time Flight Number Price AIRLINE  11:00 Sde-Dov - Eilat  14:00 70 $ per person (adult) per one way March 18th, 2008  18:20 Tuesday  10:20 52 $ per person (adult) per one way Ben-Gurion - Eilat (To Eilat)  17:30 70 $ per person (adult) per one way

Haifa - Eilat  14:20 93 $ per person (adult) per one way

Sde-Dov - Eilat  07:30 70$ per person (adult) per one way March 19th, 2008 Wednesday Ben-Gurion - Eilat  10:00 52 $ per person (adult) per one way (From Eilat) Haifa - Eilat  12:25 93 $ per person (adult) per one way  19:15 Eilat – Sde-Dov 78 $ per person (adult) per one way  21:00 March 22nd, 2008  18:55 Saturday Eilat - Ben-Gurion 69 $ per person (adult) per one way  21:55 (From Eilat) 104 $ per person (adult) per one Eilat - Haifa  19:35 way

The Price for a child – 53 $ The price for an infant – 11 $

Please note: following remarks refer to both airline companies: (1) The above prices might change according to the number of registrants of each flight. (2) Arkia / Israir reserves its right to change the type of the airplane and/or the time of the flight. (3) You may reserve the domestic flights independently. In order to find your favorable time, rate and flight, you may visit the two airlines websites – Arkia: www.arkia.co.il or Israir: www.israir.co.il. Ofakim – the organizing company will not be held responsible for these reservations.

I would like to book flight no. ______of ______airline, from ______airport to Eilat: for ______pax ______adults, ______child, ______infant. I would like to book flight no. ______of ______airline, from Eilat to ______airport; for ______pax, ______adults, ______child, ______infant.

Total for flights:

USD

F. TRANSPORTATION FROM TEL AVIV TO EILAT (by buses), cost: 18 $ per a person per one way.

______Number of people Total for bus transportation:

USD

G. CONFERENCE CANCELLATION POLICY

Up to 40 days* prior to arrival Full refund Up to 20 days* prior to arrival Full refund deducted by 50 USD handling fee 15 days to 7 days* prior to arrival 50% of accommodation will be charged, remainder of money charged by Ofakim will be refunded 7 days to the day* scheduled arrival Full charge of accommodation and registration fee

*Day = a workday according to Israel, Sunday-Thursday, not including weekends and holidays.

H. PAYMENT BY CREDIT CARD:

visa  mastercard diners * The grand total will be charged in USD; the quoted price in NIS will be converted to USD according to the daily currency exchange rate.

Card type ______Card No. ______Validity ______/______Date ______Signature ______Remarks / Requests ______Total Payment USD $ ______