Mission of Peace to Israel Registration

[Click here to download this form in Adobe Acrobat]

Dear Participant:

We are pleased that you will be joining us as a participant on the Third Annual Life Sciences Mission to Israel,
June 25–29, 2006. The trip will surely prove to be a once in a lifetime experience for you!!

We are organizing several projects in conjunction with the mission; therefore, it would be helpful if you could provide us with the materials detailed below so we may finalize our plans. All materials must be received no later than April 1, 2006.

Please send the following via fax to 212-412-9074 or email to NNovack@GlobalCapitalAssciates.com

Enclosed Personal Information Form
One paragraph detailing the kind of companies you would like to meet with in Israel or specific names of individuals / companies you would like to meet with. We will make every effort to arrange these meetings.


For publicity purposes, please send the following to NNovack@GlobalCapitalAssciates.com

One (1) copy of a professional headshot photo - as a .tif file
One (1) page biography
One (1) page description of your company

Please don’t hesitate to contact us with any questions or concerns

Global Capital Associates
P.O. Box 5336
New York, NY 10185
Phone: 212-245-0445
Fax: 347-287-6746
E-Mail: info@GlobalCapitalAssciates.com.



First and Last Name (as you would like it to appear on all materials):


Company (as you would like it to appear on all materials):


Title / Position (as you would like it to appear on all materials):


Address:
Address Line 1:
Address Line 2:
City:
State:
Zip:

Phone:


Fax:


Cell:


E-Mail:


Assistant’s:
Name
Email
Phone


Contact Number While in Israel:


Date of Birth*


Passport Number*


Passport Name*


Passport Date of Issue*


Passport Date of Expiration*


Citizenship / Passport Country*


Is this your first time to Israel?
Yes
No

Do you have any special requests?




* You may leave these fields blank and fax/email us a copy of the first page of your passport.