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Conference Registration Form
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* Indicates required question
First Name
*
Your answer
Last / Family Name
*
Your answer
Country of Residence
*
Your answer
Nationality/ies
*
Your answer
Age
*
Your answer
Gender
*
Your answer
Other identities
Your answer
Occupation
Your answer
Job Title / Role at Work
*
Your answer
Name of Organization / Place of Work
*
Your answer
What does your organization do?
(Short sentence describing the main task of the organization)
Your answer
Mobile Phone
*
Your answer
Preferred Email
*
Your answer
Home Address
*
Your answer
How did you hear about the conference?
*
Previous participant
Colleague
Email
Facebook
Web
IPPA
Psychologia Ivrit
Other
If other, please describe
Your answer
Previous Group Relations Experience
*
(This question refers to residential Group Relations conferences not other group work or training)
This is my first attendance at a Group Relations conference
I have participated in a full Group Relations conference
I have participated in more than one Group Relations conference
Required
Please fill in details of past conferences
Year, title of conference, duration, sponsoring organizations
Your answer
Topics you would like to work on in the conference, if any
Your answer
I would like a single room / shared occupancy
*
Single
Shared
If shared occupancy I would like to share a room with:
If no name is given the conference administration will assign a roommate for you.
Your answer
Dietary restrictions
Your answer
Requests / Remarks
Your answer
Registration will be completed after making your payment – please check the box with your preferred method of payment.
*
Credit card drawn on an Israeli bank via EZpay link:
https://www.ezpay.co.il/Payment.aspx?id=15433
International credit card - you will be contacted by the Administration Team
Bank transfer: OFEK, Bank Hapoalim, Branch: 778 Account:. 282858 Please add note: "for International Conference"
International bank transfer: OFEK, Bank Hapoalim, Swift: POALILIT or IBAN: IL56-0127-7800-0000-0282-858 Please add note: "for International Conference"
Other
Required
If other - please add information about payment method
Your answer
Joint Registration
For two participants from the same organization (NIS 300 discount each)
For three or more participants from the same organization (NIS 400 discount each)
Clear selection
Name(s) of joint registrants
Your answer
Discounts
I attended לגעת באפק | סדנאות וקורסים קצרים and request a discount of NIS 300
I attended an OFEK Group Relations Conference in February or July 2019 and request a discount of NIS 300
Clear selection
Details that may be shared with conference participants: Name, Occupation or Job Title/Role at Work, Place of Work, Country of Residence.
*
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Thank you for filling out the registration form.
For additional information or if you have any questions please contact Smadar Ashuach or Amir Scharf at
ofekgrc@gmail.com
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