ESM 2002 -- Electronic Registration Form

ESM'2002

DARMSTADT, JUNE 3-5, 2002

ELECTRONIC REGISTRATION FORM

Please note: This form does NOT work with Internet Explorer 3.02 or lower.
It does work fine with all versions of Netscape and other versions of Internet Explorer

First Name:
Surname:
Occupation and/or Title:
Affiliation:
Mailing Address:
Zipcode:
City:
Country:
Telephone:
Fax:
E-mail:

Yes, I will attend the 2002 ESM conference.

A. Conference Registration. (Fill in 1/2/3/4 and 5/6 if necessary) PRICES VALID TILL MAY 25TH, AFTER THAT DATE PRICES WILL BE 60 HIGHER

1. SCS Conference Member EUR 475
SCS member number:
2. Member of Sponsor or Affiliate Society EUR 475
Affiliation Society:	Eurosim JSST CASS HSS, PSS TSS
3. Non-Member participant EUR 525
4. Students who are not authors or a ONE DAY registration EUR 250
5. Extra Conference Dinner ticket for companion. EUR 50
6. Extra Conference Proceedings EUR 75
7. Add bank charge if necessary when paying by bank transfer or cheque EUR 10
TOTAL AMOUNT TO PAY IN EUR

B. PAYMENT INFORMATION

I will make payment by BANK TRANSFER to account No. 290-0033837-05 SCS Europe BVBA, FORTIS BANK, Branch Office Ghent Centre, Kouter 6, B-9000 Ghent, Belgium IBAN CODE: BE96290003383705, SWIFT CODE: GEN: GEBABEBB-05A, MENTION YOUR NAME and ESM'2002 (make a print of this form so you know what you submitted)

I will pay by CHEQUE and send it to Philippe Geril, SCS Europe Bvba, European Simulation Office, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium. (make a print of this form so you know what you submitted)

I will pay by CREDIT CARD but do not send the information with the form. Please phone me for the credit card information

I will pay by CREDIT CARD and fill in the information below. Please note: credit card information is not yet encrypted in this e-mail. If this is a problem: fax the credit card information separately, or discuss the payment information with Philippe Geril by phone or by e-mail.

Type of card
Card no
Cardholder name
Exp.Date

If e-mail fails, you can also print this information and send / fax it to:
Philippe Geril, SCS Europe Bvba,
European Simulation Office, Ghent University,
Coupure Links 653, B-9000 Ghent, Belgium
Phone: +32-9-2337790, Fax: +32-9-2234941