Yad Vashem course application form

Please print, fill and fax this form to:
+972-2-6433511

Name  _____________________________________

Home Address   _________________________________

Home Tel. No.   __________ Home Fax No. ________

Home email _________________________________

Male ___ Female ___

Place of work _______________________________

Work Address _______________________________

Work Tel. No. _____________ Fax Tel. No. ________

Job Description _____________________________

Please indicate which of the following is applicable:

[ ] 1. I will arrange my own accomodation

[ ] 2. will require hotel accomodation:

[ ] Single room

[ ] Double room shared with other participant

Citizenship ____________________________

Passport No. ___________________________

Date of arrival ___________________________

Date of departure ________________________

To be Submitted with the this application:

Complete curriculum vitae
Statement of personal reasons for wishing to attend the course
50.00 $ non-refundable application fee

Documentation must be submitted by April 15, 1999
(For Winter Seminar, Oct 15, 1999)
Notification of acceptance will be mailed by May 15, 1999
(for Winter Seminar, Nov 15, 1999)

Please print, fill and fax this form to: +972-2-6433511

To be Submitted with the this application:

Please print, fill and fax this form to:
+972-2-6433511