ESS'2001

 

 

MARSEILLE, OCTOBER 18-20, 2001

ELECTRONIC REGISTRATION FORM

(or use the fax/mail form)

scs100.gif (2365 bytes)

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 2001 ESS conference.

A. Conference Registration. (Fill in 1/2/3/4 and 5/6 if necessary) PRICES VALID TILL OCTOBER 1ST

1. SCS Conference Member
EURO 475
SCS member number:
2. Member of Sponsor or Affiliate Society
EURO 475
Affiliation Society: Eurosim JSST CASS CSSS
HSS, LSS PSS TSS
3. Non-Member participant
EURO 525
4. Students who are not authors or a ONE DAY registration
EURO 250
5. Extra Conference Dinner ticket
for companion. EURO 60
6. Extra Conference Proceedings
EURO 125
7. Add bank charge if necessary
when paying by bank transfer or cheque
EURO 10
TOTAL AMOUNT TO PAY IN EURO


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 ESS'2001 (make a print of this form so you know what you submitted)
I will pay by CHEQUE and send it to Philippe Geril, SCS European Office, European Simulation Office, University of Ghent, 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


Page created by Philippe Geril Last update 03-02-03.
Copyright SCS Europe Bvba  - All Rights Reserved