Contact details

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* 1. Full name

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* 2. Address

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* 3. Zip or area code

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* 4. City

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* 5. Country

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* 6. Nationality

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* 7. Telephone (cell)

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* 8. Email address

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* 9. Gender

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* 10. Age

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* 11. Occupation

Conference participation

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* 12. Do you have academic affiliation? Any other?

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* 13. Please, specify your fields of interest:

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* 14. Please, write a short Bio on yourself (up to 200 words)

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* 15. In what character would you like to participate in the conference?

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* 16. Please submit an abstract of the paper you would like to present (up to 200 words)

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* 17. What is the title of the paper?

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* 18. How did you hear about the conference?

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* 19. Kosher-style food will be served during the conference (vegetarian + fish). Please let us know if you have any other specific request by choosing from the list below. (If you request supervised kosher food please select the 'certified kosher' option from the list)

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* 20. I consent to my personal data being used by JDC-ICCD for the purpose of sharing contact details only with other conference participants and to receive JDC-ICCD information

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100% of survey complete.

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