Please print and fax the completed form to:  +972-2-644-3429

Registration Details
Name____________________________________________
Church Affiliation___________________________________
Telephone (work)__________________________________
Telephone (home)__________________________________
Mobile____________________________________________
E-mail____________________________________________

Contact Details in Israel
Hotel ____________________________________________
Phone (optional)___________________________________

Method of Payment
1) Credit Card
□ Mastercard     □ Visa     □ American Express
Amount:  $150.00
Cardholder’s name _____________________________
Card number __________________________________
3 digit security code________________ Expiration date ____________

Signature _____________________________

Please send via fax +972-2-644-3429

2) Check
Checks may be made payable to “Yad Vashem” and mailed together with a completed form to:
Yad Vashem, International Relations Division
Christian Friends of Yad Vashem
P.O. Box 3477
Jerusalem  91034  Israel