ESS'2001

October 18-20, Marseille, France

European Simulation Symposium 2001
FAX/MAIL REPLY FORM

(or use the electronic form)

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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
 
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REGISTRATION AND PAYMENT (PRICES VALID TILL OCTOBER 1ST)
A.CONFERENCE REGISTRATION
(Check appropriate boxes)
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: __ __ / __ __

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


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