XIVth INTERNATIONAL PLANT PROTECTION CONGRESS

You may fill the form below and send it through this web site.
The form may also be sent by e-mail or fax to the secretariat at:
Secretariat
XIVth International Plant Protection Congress
P.O.Box 50006, Tel-Aviv 61500 Israel
Tel: 972-3-5140000
Fax: 972-3-5175674 or 972-3-5140077
E-Mail : ippc@kenes.com

IDENTIFICATION
Please complete this section accurately; the information you provide will allow us to correspond with you efficiently, and it will also be used for your delegate badge at the Congress..
*Fields printed in red are required and must be filled

Participant
Surname:
First Name:
Title:
Department:
Institution:
No:
Street:
Suite/Apt.:
City :
State/Province:
Country:
Postal Code:
Telphone:
Fax:
E mail:
Mailing Address if Different From Above
No:
Street:
Suite/Apt.:
City :
State/Province:
Country:
Postal Code:
Accompanying Persons List only those individuals registering for the Accompanying Person's program
Surname
First Name
Title
Surname
First Name
Title
Surname
First Name
Title
Registration Fees Please check the appropriate box/es	"Early Bird" Until April 25,1999	Late Registration After April 26,1999
Participant	$410	$480
Accompanying Person *	$120	$120
Professional Field Trip
First choice no:
Second choice no:
Number of places x	$60	$60
Farewell Dinner *	$50	$50
	"Early Bird" Until June 25,1999	Late Registration After June 26,1999
Student	$150	$180

Payment
Total Fees	$
Method of Payment
Check sent via airmail made patable to :XIVth International Plant Protection Congress	Check Number:	Bank:
Bank Transfer -with your name and address indicated on the reverse. If payment is made for more than one person or by a company please make sure all names are indicated and send fully completed registration forms together with a copy of the bank transfer. Please make drafts payable to : “XIVth International Plant Protection Congress" and send them to Bank Leumi Le’Israel, Gan Hair Branch, Tel-Aviv, Israel, Account number 654/56036/72 Patam. Bank charges are the responsibility of the payee and should be paid at source in addition to the registration fees.
Credit Card	Visa : Mastercard: Dinners:
Card Number
Expiration date
Names as shown on credit card
Western Union Quick Pay Pay in cash in local currency with Western Union Quick Pay. Take your payment to the nearest Western Union location and complete the blue Quick Pay form with the following information: Company name:Kenes Tours Locale/Code City:KENES, IK Account Number:Please write Name of Conference Name/Department:Please write the word "Registration" Western Union will send your payment to us electronically. For the Western Union Location nearest to you, consult your local telephone directory.
If you print this form and send it by fax or airmail please sighn here _________

Cancellation policy:
Refund of Registration Fees will be made as follows:
Post-marked prior to April 25, 1999 - full refund less US$ 50 handling fee
Post-marked from April 26, 1999 - 50% refund
Post-marked after June 30, 1999 - no refund

Congress Secretariat:
KENES Organizers of Congresses and Tour Operators Ltd.
PO Box 50006, Tel Aviv 61500, Israel;
Tel: +972 3 5140014; Fax: +972 3 5175674 / 5140077

E-Mail: IPPC@Kenes.com