UFTAA CONGRESS

Participant Status:

Representing Association

Affiliate

Non Member

First :

Middle :

Last :

Name of TRAVEL AGENCY / COMPANY :

Your Designation/Position in the Agency :

Address :

Country :

Zip Code :

Phone :

Mobile :

Email :

Skype :

Name of Association / Name of Affiliate (Travel Agency) / Other :

Participant’s Position in Member organization/Agency :

REGISTRATION PACKAGE DETAILS (Please PRINT)
Type of Registration	Room Type	FEE	Payment (Euros)
Congress Package (Including 2 nights) subsidized Accommodation	Single	Euro 500
Congress Package (Including 2 nights) subsidized Accommodation	Double/Twin	Euro 350 PP
Additional Nights ( Nights)	Single/Twin	Euro 250 Per Night
Congress Packagie without Accommodation	NIL	Euro 300
ADD BANK Charges for Credit Card		EURO 25
TOTAL EUROS

PAYMENT SENT :

BY BANK TRANSFER

PAYMENT BY CREDIT CARD

NAME ON CREDIT CARD :

NUMBER :

EXP DATE/VALID THRU ON CARD :

CVV :

Please check if there is an Embassy/Consulate of Israel in your country issuing Visas to Israel. You may be required to apply for visa in your country or Region.
Visa is subject to applicant’s documents. It is the responsibility of the delegate. The association coordinating the Congress & AGA will try and assist. Conditions Apply
Visa must be applied well in advance. Please ensure timely application. Each country may have its own visa application form with requirements. Please check. (For instance, in some countries, Valid Overseas Health Cover for atleast US$ 40,000; is required; or Personal Bank Statement for previous 6 months with balance, duly certified by Bank Is required.
Acceptance of your form for processing and payment of processing fee does not guarantee grant of the visa. The granting of the visa is entirely the prerogative and at the discretion of the Embassy / Consul of Israel and no reasons will be provided for the delay/denial of a visa.

GIVEN NAME /FIRST NAME	MIDDLE NAME	FAMILY NAME/LAST NAME

Previous FAMILY NAME, if any	MOTHER’S NAME	FATHER’S NAME

OCCUPATION	DATE OF BIRTH	COUNTRY OF BIRTH

GRAND FATHER’s NAME	Country of RESIDENCE	From which year in country of Residence

COUNTRIES VISITED	SEX	Your VALID VISAS

Home Address (Street and House Number with city; pin code and country)

Home Telephone	Fax	Mobile Number

Email ID (1)	Email ID (2)	Emergency Contact

PRESENT NATIONALITY	PREVIOUS NATIONALITY	PASSPORT NUMBER (Attach Passport copy)

HEALTH RESTRICTION	Health Insurance No. Overseas Health Cover	PASSPORT – DATE OF ISSUE & DATE OF EXPIRY
		\|
FAMILY STATUS : Married / Single / Divorced / Widow
Previous visits to Israel
Nature of Previous visits
Previously Hosted by Min. of Tourism (if YES, give details)
Name of your Agency / Company	JOB TITLE / POSITION	COUNTRY

Business Address with Street No. / Building No; City; Pin Code & Country

Business Phone	Business Email ID	Dietary Restrictions

Attach Passport Copy :

Submit