Registration Form Video Conference

Contact name*
e-mail*
Phone*

Name of School*
Address
e-mail
Phone*
Web Address

Description of School*
Target community*
Age
Did students visited the Western Wall?
Did students participated in a Videoconference before?
Religion:
Comments:
Number of participants*

Hours Differences*

Tech Person*
e-mail*
Phone*

Video Conference System
ISDN / IP number*
Phone during broadcast*