Primary Author/Presenter

Primary Author/Presenter
 

Primary Author/Presenter Organization or Affiliation
 

Primary Author/Presenter Address

Primary Author/Presenter Phone
 

Primary Author/Presenter Mobile
 

Primary Author/Presenter Fax
 

Primary Author/Presenter e-mail
 

Primary Author/Presenter/Organization web page
 

If there are Co and/or Associate Authors/Presenters Kindly share with us their names, Organization or Affiliation and contact information

The Abstract

Paper/Presentation Title:

Paper/Presentation Abstract (Max 500 words)

What type/types of Presentation will you Share/Present at the Workshop? Discussion Exercise Experiential Workshop Film/Movie Impress/Power Point Presentation LectureOther (Please Specify) 

Please provide 3 keywords that best describe the topical focus of your presentation.

Keyword 1: 

Keyword 2: 

Keyword 3: 

What is significantly unique, timely, different or original about your abstract/presentation topic?

What Type of Equipment will you need for the Presentation?
Kindly note that our supplies are limited, so kindly ask only for items that are absolutely essential for the presentation
 Computer Internet connection Projector DVD Speakers CD Player Flipchart

How much time do you need to present the presentation?
 30 Minutes – 1/2 hour 60 Minutes – 1 hour 90 Minutes – 1 1/2 hours  120 Minutes – 2 hours 150 Minutes – 2 1/2 hours 180 Minutes – 3 hours

If your presentation must be scheduled for a certain time or a certain location (i.e. outdoors, in a classroom etc.) or if you have any additional comments, special needs and/or requests kindly indicate below.

Your First Name
 

Your Family Name
 

Contact Information

Your Email
 

Street and Street Number
 

Entrance Number/Apartment Number
 

Post Office Box
 

City/Town/Village
 

State/Province/Department/Region
 

Country/State/Authority
 

Postal Code/Zip Code
 

Your Home Phone
 

Your Mobile Phone
 

Your Work/Organization Phone Number
 

About You

Your Profession
 

Your Place of Employment/Organization/NGO/School
 

Languages that You Speak and/or Understand
 English Hebrew Arabic

Accomodations

Would you like to reserve a bed in Talitha Kumi for Friday Evening, March 12, 2010? (The price of a Bed is 50 NIS/$15 USD per night)
 Yes No

If you do not need a bed in Talitha Kumi for Friday Evening, March 12, 2010, would you be willing to host in your home other workshop participants? If so, how many people can you host in your home to sleep on Friday Evening, March 12, 2010   012345678910

Will you need a private room (double bed) at Talitha Kumi for Friday Evening, December 18, 2009 for you and your partner/spouse? If so kindly indicate the name of your partner.
 

If you are coming without a partner/spouse and you would like to reserve a bed in Talitha Kumi for Friday Evening, December 18, 2009 what is your gender? (It is the policy of IPCRI to place participants in rooms with people of the same gender and from different nationalities)
 Female Male

Name of Country/State/Authority that issued the ID document that you will use to register to stay at the at the Talitha Kumi Guest House
 

The ID Number on the ID document that you will use to register to stay at the at the Talitha Kumi Guest House
 

Explanation of Payment

The price for the workshop for 2 days, including meals and participation in all program activities (without a bed at the Talitha Kumi Guest House) is 300 NIS ($70).

The price for the workshop for 2 days, including meals and participation in all program activities (with a bed at the Talitha Kumi Guest House) 350 NIS ($85).

These costs do not include any salary money for IPCRI staff who will be working hundreds of hours preparing and planning the workshop.

IPCRI has no funding for this conference. We are asking everyone to pay something. The minimum payment is 100 NIS ($25). We hope that most people will be able to cover their full expenses. We will be glad if you can pay MORE than the full cost so that we can sponsor more people who are not able to pay the full costs themselves. We would appreciate if you pay for the workshop prior to arriving to the Peace Education Workshop. It is possible to pay when you arrive to the workshop but if you pay now, we will assure your place at the workshop.

How much will you pay (minimum 100 nis ($25))(required) 

Payment can be made by a money order or by check made out to IPCRI (in US dollars, Euro, or Shekels) and sent to:
IPCRI
PO Box 9321
Jerusalem 91092
Please post the check on or before March 1, 2010 in order to allow enough time for the payment to arrive at IPCRI’s offices before the Peace Education Workshop.
Secure online payments may be made by credit card:

In US Dollars: http://www.ipcri.org/donate.html (Please indicate PEW-August)

In Israeli shekels (this page is only in Hebrew): http://www.litrom.com/ipcri

How do you intend to you pay the Workshop Registration Fee?
 By Check By Cash By Credit Card in US Dollars By Credit Card in Shekels

Your Special Message/Requests/Comments/Questions