Registration form Registration has now closed. If you have any questions about registration, please email us – email@example.com. Welcome to the PLPR Conference 2014 registration page! Please note that due to various administrative requirements, you cannot pay directly through this site. Once you submit this form, you will receive an email with a link to pay through Paypal. Registration closes 10 January 2014. Cancellations will be accepted with fees refunded until 20 January. Personal DetailsName* First Last Passport Number (Israelis please enter ID number)*This detail is required in order for payments to be processed by the Technion.InstitutionEmail* PhoneAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Dietary RequirementsWe will do our best to accommodate your needs.Payment DetailsConference Registration*Member - $275Non-member - $300Student - $150Member one day - $100Non-member one day - $120Students one day - $60PLPR membership is free - sign up now if you have not already. Details at www.plpr-association.org/Accompanying Persons - Social Activities Price: $80.00 Quantity: Includes opening reception, closing lunch and reception at Bahai World Centre and post-conference tour of Haifa and surrounds.Pre-conference workshops*No workshopOne workshop - $40Both workshops - $80If you are attending one or two workshops, please ensure that you have filled in the Workshop Registration Form (link at top of site).Pre-conference workshops - Accompanying personsOne workshop - $40Both workshops - $80Please ensure that you have filled in the Workshop Registration Form (link at top of site) separately for each accompanying person.Conference dinner* Price: $80.00 Quantity: Enter '0' for 'quantity' if not attending.Conference dinner - student price* Price: $50.00 Quantity: Enter '0' for 'quantity' if not attending.Total to pay $0.00 You will receive an email with a link to pay by Paypal within one week of submission of this form. Please remember to check your spam folders!Israeli citizens or institutions: please mark the box below to pay by cheque Pay by cheque in NIS NameThis field is for validation purposes and should be left unchanged.