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:
:

Company: Reg.# ).(:

Address: City: Zip:
Cellular: Email:
Telephone: Fax:
Name of signatory: Telephone of signatory:
Choose registration date:
ILS 450 ILS 550 ILS 650 ILS 780
till 28/2/2017 till 30/3/17 till 19/4/17 regular price

I also wish to register for the Half-Day Seminar (in addition to the conference): ILS 350
Total to pay: _______
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
Sponsors:

Startup Zone:

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