כנס החוג לקיצוב לב 26-28.10.23

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Personal Information

Title

* First Name

* Last Name

* Institute / Company

* Phone Number

* Email Address

*

I agree to receive messages including confirmations, instructions and other messages to the email address and phone number I provided.

Registration

Please note: The conference is exclusively for members of the Israel Heart Society.

*

With Accommodation (Dan Accadia Hotel)

Without Accommodation

Registration without accommodation

*

Cardiologist

Intern/Other

*

Registration for both conference days - 26 and 27.10 - 100 NIS

Registration for the first day only - 26.10 - 50 NIS

Registration for the second day only - 27.10 -- 50 NIS

*

Registration for both conference days - 26 and 27.10 - 60 NIS

Registration for the first day only - 26.10 - 30 NIS

Registration for the second day only - 27.10 - 30 NIS

Enrichment lecture on Thursday evening

I would like register for the enrichment lecture on Thursday evening - 50 NIS

Registration with accommodation

The rate is for two nights and is including participation at the conference,

accommodation on a half board basis and social events.

Kindly make advance room reservations, as the availability of rooms is limited.

*

Cardiologist

Intern/Other

*

Single Room - 2318 NIS

Double Room - 2810 NIS

*

Single Room - 1818 NIS

Double Room - 2310 NIS

* Will your partner be joining us for our Friday lunch at the cost of 157 NIS?

Yes

No

Special Requests

I am Shomer Shabbat

Allergies

Other Special Requests

Payment

Item	Amount	Price	Subtotal
Subtotal			Subtotal	₪
Discount
Credit Card Fee		Credit Card Fee	2.00%
Total			Total	₪

Total Amount

0.00 ₪

* Payment Method

*

I agree to make out a check

2% Credit Card fee will be charged

After submitting the form you will be redirected to a secure website to perform the transaction. Only after doing so will your registration be completed.

Invoice/Receipt Information

* Email address for invoice/receipt

* Name for invoice/receipt

* Address

* City

* Private Company/Licensed Dealer/ID

9 digits (if less than 9, pad with leading zeros)

* Institute Name

* Institute Number

* Institute's accounting contact

* Institute's accounting phone

* Institute's billing address

Account details for transfer:

Account name: Kelim Shluvim ltd

Bank details: the first international bank 31

Branch: 051, Account Number: 241814

The name of the participant must be indicated in the transfer details and a transfer confirmation should be sent to the email: office@ks-team.co.il

*

I agree to make a bank transfer of the aforementioned amount

After submitting the form you will be redirected to PayPal to confirm the transaction. Only after doing so will your registration be completed.

Invitation code

In order to verify that you were invited, please fill in the code you recieved when invited

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