Unbenanntes Dokument

mr / mrs / ms:

surname:

first name:

mailing address:

email:

city:

country:

zip code:

tel:

cell phone:

male female

date of birth:

/ /

for security reasons please inform us which jewish community or synagogue you attend:

ACCOMODATION

double room € 390,-

I would like to share a room with:

Remarks:

PAYMENT

credit card:

we accept Visa, MasterCard and American Express.

credit card:

VISA MasterCard
American Express

card number:

valid until:

/

name on card:

EC-card:

acct. no.:

bank code:

Full payment of the registration fee is required in advance to confirm your reservation. Please send a cheque or bank transfer in Euro (to reduce the bank charges incurred): Rates do not include transportation or transfers.

Gady Gronich, Isartalstr. 34, D-80469 Munich, Germany
Postbank Munich, acct. no. 804-24-804, bank code 700 100 80, IBAN: DE77 7001 0080 0080 4248 04 swiftcode: PBNKDEFF, reference “different in zurich”

cancellations:
In case of cancellation prior to FEBRUARY 16TH, 2005 there will be no cancellation fee, after that date we will charge 100% cancellation fee.

I hereby authorize you to charge my credit card / EC-card as stipulated above.