EUROMEDIA 2000 -- Electronic Registration Form

2000

ANTWERP, MAY 8-10, 2000

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 2000 EuroMedia conference.

A. Conference Registration. (Fill in 1/2/3/4 and 5/6 if necessary)

1. SCS Conference Member EURO 450
SCS member number:
2. Member of Sponsor or Affiliate Society EURO 450
Affiliation Society:	Eurosim JSST CASS CSSS HSS, LSS PSS TSS
3. Non-Member participant EURO 500
4. Students who are not authors or a ONE DAY registration EURO 250
5. Extra Conference Dinner ticket for companion. EURO 40
6. Add 21% VAT (Value Added Tax)
7. Add bank charge if necessary when paying by bank transfer or cheque EURO 10
TOTAL AMOUNT TO PAY IN EURO PLUS VAT

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 MENTION YOUR NAME and EUROMEDIA'2000 (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 encrypted in the 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, 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