Registration form IVS2017

* required fields *Family Name: *Given Name: *Affiliation (please mark): Ariel University Ben-Gurion University of the Negev Bar-Ilan University Holon Institute of Technology The Hebrew University of Jerusalem The Open University of Israel The Technion Tel-Aviv University Weizmann Institute of Science Other academic institute Other type of organization *Mailing address:
*Street: *City: *Country: *Postal code: Mobile phone: Work phone: Fax: *E-mail: *I plan to attend mainly the following sessions (please mark up to 3 options): Session Nanomaterials: advanced fabrication and characterizationSession Basic and applied surface scienceSession Energy and SustainabilitySession Responsive Surface and ElectrochemistrySession Mechanical Properties and TribologySession Bio-Interfaces, soft Matter and MicrofluidicsSession Nano Electronics and SpintronicsSession Photonics and Plasmonics *Presenting (please check at least one option): I do not intend to presentI intend to present an oral presentationI intend to present a poster presentation *Name to appear on invoice: *Fees (please mark your status): Conference & Workshop- Standard - 725 NISConference - Standard - 550 NISWorkshop - Standard - 225 NISConference & Workshop- Postdoc - 500 NISConference - Postdoc - 400 NISWorkshop - Postdoc - 150 NISConference & Workshop- Student/Retiree - 425 NISConference - Student/Retiree - 325 NISWorkshop only- Student/Retiree - 100 NIS Please mark:  (optional) I would like to be an IVS member for the incoming year. *I have read the general terms of the site, and accept them. *Please enter the numbers: