Israeli Dances - Karmiel Registration

2012 KARMIEL SUMMER COURSE REGISTRATION

Please use this form below to register your interest in the 2012 course.
This information goes directly to Dany Benshalom, Course Coordinator.

First Name:

Last Name:

Age:

Gender:

Passport No:

Country:

State:

City:

Suburb:

Zip Code:

Street Line 1:

Street Line 2:

Email Address:

Skype Name:

Airline and Flight No:

Arrival Date: (dd/mm/yyyy)

Arrival Time: :

Vegetarian:

Please include Country and Area Codes for Contact Phones
without the leading 0 of Area Code (ie 972 3 3456789).
Click here for list of Country and City Codes

Contact Phone 1:

Country Code	Area Code	Phone Number

Contact Phone 2:

Country Code	Area Code	Phone Number

Passport-Format Photo
(not your passport):

Comments: