ESM'2002 Fax Registration Form

ESM'2002

European Simulation Multiconference 2002
FAX/MAIL REPLY FORM

Please legibly print or type and fill out completely.

FIRST NAME	LAST NAME	M.I.
COMPANY OR AFFILIATION
Mailing address (tick one): [ ] HOME [ ] BUSINESS
STREET
CITY
ZIPCODE	COUNTRY
TELEPHONE	FAX
E-MAIL
DATE	SIGNATURE

REGISTRATION AND PAYMENT (PRICES VALID TILL MAY 25TH) A.CONFERENCE REGISTRATION (Check appropriate boxes)
1. [ ] SCS member 475 Member Number:_____________________________	___________
2. [ ] Members of Sponsor or Affiliate Society 475 Circle your affiliation: EUROSIM JSST CASS HSS PSS TSS	___________
3. [ ] Non-Member Participant 535	___________
4. [ ] For registration AFTER MAY 25TH, add 60	___________
5. [ ] Students, who are not authors but who wish to attend the conference pay, or ONE DAY PARTICIPANTS: 250	___________
(Above registration fees include, one copy of the PROCEEDINGS, all midday meals, cocktail, refreshments, coffees and social program, except for students and One-Day Participants where the Conference Proceedings are NOT INCLUDED.)
6. [ ] Conference Dinner Ticket for Companion 50	___________
7. [ ] Extra Conference Proceedings 75	___________
TOTAL AMOUNT DUE	___________
ADD BANK CHARGE of ( 10) in case you pay by BANKTRANSFER or CHEQUE.	___________
TOTAL AMOUNT REMITTED	___________

[ ] 1)	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
[ ] 2)	Or pay by CHEQUEand send it to SCS Europe Bvba, European Simulation Office, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium.
[ ] 3)	Or pay by CREDIT CARDand fill in the information below:
	Charge my (tick one): [ ]Visa [ ] Euro/Mastercard [ ] American Express [ ]Diners CARD NO: __ __ __ __ : __ __ __ __ : __ __ __ __ : __ __ __ __ EXP.DATE: __ __ / __ __
	Authorizing Signature: PRINT AUTHORIZATION NAME:______________________________________

PURCHASE ORDERS ARE NOT ACCEPTED UNLESS GUARANTEED BY A CREDIT CARD NUMBER.

MAIL REGISTRATION FORM AND PAYMENT FORM COPY (1) / CHEQUE (2) / CREDITCARD INFO (3) TO:
SCS Europe Bvba,
European Simulation Office, Ghent University,
Coupure Links 653, B-9000 Ghent, Belgium
Phone: +32-9-2337790, Fax: +32-9-2234941