/ Beit Issie Shapiro’s

4th INTERNATIONAL CONFERENCE ON DEVELOPMENTAL DISABILITIES: POLICY, PRACTICE AND RESEARCH

“Partnerships for Progress”

David Intercontinental Hotel, Tel Aviv, Israel, July 4 – 6, 2006

REGISTRATION FORM

(Please complete the form below, in clear CAPITAL LETTERS, and return to:

Ortra Ltd., PO Box 9352, Tel Aviv, 61092 Israel, Fax: 972-3-6384455; e-mail: )

Title:  Prof.  Dr.  Mr.  Mrs.  Ms.

Surname: ______First Name: ______

Affiliation: ______

Address:  Institution  Home ______

______City:______

Country: ______Zip/Code:______

Tel: ______Fax: ______E-Mail: ______

Accompanying Persons:

Surname: ______First Name: ______

Surname: ______First Name: ______

Conference Registration Fees:

Early Registration
until May 22, 2006 / Late Registration
from May 23, 2004
Participant /  US$ 380 /  US$ 420

Registration to the Satellite Conference: International Hydrotherapy Conference

Sunday – Monday, July 2-3, 2006

1-day participation in lectures program: /  US$ 50
Sunday / Monday
2-day participation in lectures program: /  US$ 90
1-day participation in lectures program + workshop: /  US$ 160
Lectures: Sunday / Monday
Workshop: Sunday / Monday
Participation in the workshop only (1-day): /  US$ 120
Sunday / Monday

I am disabled and I need the following: ______

Payment:

Attached is payment in the amount of US $ ______made out to Ortra Ltd. by:

 Bank Draft # ______

 Bank transfer to account # 142-472330, Bank Hapoalim (swift code poalilit), Branch 780,

Itzhak Sade St., Tel-Aviv, Israel. Copy of bank transfer document enclosed.

 Please charge my  Mastercard/Eurocard  Visa  American Express  Diners

Card # ______Expiry date ______

Credit card owner:______

Signature ______Date ______

/ Beit Issie Shapiro’s

4th INTERNATIONAL CONFERENCE ON DEVELOPMENTAL DISABILITIES: POLICY, PRACTICE AND RESEARCH

“Partnerships for Progress”

David Intercontinental Hotel, Tel Aviv, Israel, July 4 – 6, 2006

TOURIST SERVICES FORM

(Please complete the form below, in clear CAPITAL LETTERS, and return to:

Ortra Ltd., PO Box 9352, Tel Aviv, 61092 Israel, Fax: 972-3-6384455; e-mail: )

Title:  Prof.  Dr.  Mr.  Mrs.  Ms.

Surname: ______First Name: ______

Affiliation: ______

Address:  Institution  Home ______

______City:______

Country: ______Zip/Code:______

Tel: ______Fax: ______E-Mail: ______

Accompanying Persons:

Surname: ______First Name: ______

Surname: ______First Name: ______

Please make the following reservations:

A. AIRPORT TRANSFERS

 I require private transfer from Ben Gurion International Airport to my hotel at US$32 per car.

 I am scheduled to arrive on: Date______Flight ______From______Time______

 I shall inform you of flight details at a later date, but no later than one week prior to arrival.

B. DAILY ACCOMMODATION RATES

Double Room / Single Room
Intercontinental Hotel (5 star deluxe, Conference Venue) /  US$ 215 /  US$ 193
Dan Panorama Hotel (5 star, adjacent) /  US$ 145 /  US$ 135
Metropolitan Hotel (4 star, 25 minute walk) /  US$ 90 /  US$ 75

Dates: From______To: ______Total # of Nights: ______

I am disabled and I need the following: ______

C. OPTIONAL TOURS

C.1. Jerusalem – Full Day Tour at US$ 52 per person

Monday, July 3 or Friday, July 7

C.2. Masada, Dead Sea and Ein Gedi Hot Springs Full Day Tour at US$ 67 per person

Sunday, July 2 or Sunday, July 9

C.3. Nazareth, Capernaum, Sea of Galilee and Tiberias Full Day Tour at US$ 55 per person

 Saturday, July 1 or Saturday, July 8

C.4. Caesarea, Haifa, Acre, Rosh Hanikra Full Day Tour on Tuesday, July 4 at US$ 60 per person

C.5. Jerusalem – Old City Half Day Tour on Thursday, July 6 at US$ 27 per person

PAYMENT

Attached is payment in the amount of US $ ______made out to Ortra Ltd. by:

 Bank Draft # ______

 Bank transfer to account # 142-472330, Bank Hapoalim (swift code poalilit), Branch 780, Itzhak Sade St., Tel-Aviv,

Israel. Copy of bank transfer document enclosed.

 Please charge my  Mastercard/Eurocard  Visa  American Express  Diners

Card # ______Expiry date ______

Credit card owner:______

Signature ______Date ______