David and Janet Polak Visitors Center

Dear Madam/Sir,

Thank you for your interest in visiting the Technion. To help us arrange a suitable visit for you, please complete the form below.

Name*

Phone Number*

Email*

Guest(s) names, titles and organization/affiliation*

If necessary upload your list here

Country of origin*

City / State of origin*

Number of guest(s)*

If there are children (under 13) please state their ages

Preferred date and time frame for the visit – Please indicate preferred time*

Preferred Visit Starting Time*

What is the purpose of the visit?*

Please state the visit purpose*

Do the guest(s) have existing connections at the Technion?*

What is the nature of their visit to Israel?*

From which location in Israel will the guest(s) be arriving?*

Who will be the contact person for planning the visit – name, email, cell phone number?*

Name and local cell phone number of the contact person for the day of the visit (if different from above)

Means of transportation (car make and license number)*

Preferred Language for Your Tour*

Would you like the local Society to contact you if available in your area?*

Additional Comments