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Please legibly print or type and fill out completely.
| FIRST NAME |
LAST NAME |
M.I. |
| COMPANY OR AFFILIATION |
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| Mailing address (tick one): [ ] HOME [ ] BUSINESS | ||
| STREET |
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| CITY |
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| ZIPCODE |
COUNTRY |
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| TELEPHONE |
FAX |
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| E-MAIL |
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| DATE |
SIGNATURE |
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| REGISTRATION AND PAYMENT
(PRICES VALID TILL OCTOBER 1ST) A.CONFERENCE REGISTRATION (Check appropriate boxes) |
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| 1. [ ] SCS member EURO 475 Member Number:_____________________________ |
EURO ___________ |
| 2. [ ] Members of Sponsor or Affiliate Society
EURO 475 Circle your affiliation: EUROSIM JSST CASS CSSS HSS LSS PSS TSS |
EURO ___________ |
| 3. [ ] Non-Member Participant EURO 525 |
EURO ___________ |
| 4. [ ] For registration AFTER OCTOBER 1, add EURO 50 |
EURO ___________ |
| 5. [ ] Students, who are not authors
but who wish to attend the conference pay: EURO 250 |
EURO ___________ |
| (Above registration fees include, one copy of the PROCEEDINGS, all midday meals, cocktail, refreshments, coffees and social program, except for students where the Conference Proceedings are NOT INCLUDED.) | |
| 6. [ ] Conference Dinner Ticket for Companion EURO 60 |
EURO ___________ |
| 7. [ ] Extra Conference Proceedings EURO 125 |
EURO ___________ |
| TOTAL AMOUNT DUE | EURO ___________ |
| ADD BANK CHARGE of (EURO 15) in case you pay by BANKRTANSFER or CHEQUE. | EURO ___________ |
| TOTAL AMOUNT REMITTED | EURO ___________ |
[ ] 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 ESS'2001 |
| [ ] 2) | Or pay by CHEQUEand send it to SCS European Office, European Simulation Office, University of Ghent, 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: __ __ / __ __ |
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| 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:
The Society for Computer Simulation International,
European Simulation Office, University of Ghent,
Coupure Links 653, B-9000 Ghent, Belgium
Phone: +32-9-2337790, Fax: +32-9-2234941
Page created by SCS Europe Office. Last update 03-02-03.
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