Camp BITNUA, October 23rd-26th 2019: Registration Form
Filling up the online registration form does not assure your official participation.
You must have a confirmation number which will be given to you by Hila Mukdasi.
Email address *
First Name *
Your answer
Last Name *
Your answer
Israeli No. / Phone No. (including state code) *
Your answer
State *
Your answer
City *
Your answer
Registered by: *
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Hotel Requested *
Number of people in the room *
SELECT YOUR PREFERRED OPTION: *
(Costs for Wednesday to Saturday only)
Required
Credit Card No. *
Those who prefer passing by private can contact: +972526966019 (Hila)
Your answer
Expiration Date (Month / Year) *
Your answer
CVV *
Your answer
Total amount of charge (For the camp only): *
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Roommate's Full name: *
Your answer
Roommate's Phone No.: *
Your answer
Roommate's State and City *
Your answer
Roommate's Full name:
Your answer
Roommate's Phone No.:
Your answer
Roommate's State and City
Your answer
Roommate's Full name:
Your answer
Roommate's Phone No.:
Your answer
Roommate's State and City
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Special Requests / Notes
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I hereby approve the registration and charge for CAMP BITNUA 2019, Eilat, Israel *
Required
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