The 2nd International Conference in Palliative Care – “Palliative Care in Different Cultures” March 19-22, 2008, Herods Hotel, Eilat Israel REGISTRATION FORM Please PRINT in BLOCK LETTERS and AIRMAIL or FAX to: OFAKIM Travel and Tours (Mrs. Dorit Heldenberg) 82 Menachem Begin St. Tel Aviv, 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, India 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 Haifa - 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 $ __________________ .