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

A.	CONFERENCE REGISTRATION
1.	BASIC REGISTRATION FEE SCS or AFFILIATE MEMBERS. Please, tick all boxes that apply. Member of: [ ] SCS [ ]  Eurosim [ ] CASS [ ] JSTT [ ]	[ ] BF 20.000 [ ] ECU 500
2.	IF YOU ARE NOT AN SCS OR AFFILIATE MEMER: ADDITIONAL FEE (Fees include all lunches, coffees, conference dinner and conference proceedings)	[ ] BF 2.000 [ ] ECU 50
	VAT Number if applicable:
	REGISTRATION FEE DUE	BF___________
	ADD BANK CHARGE of BF 350 (9ECU) in case you pay by BANK or CHEQUE.	BF___________
	TOTAL AMOUNT REMITTED	BF___________

[ ] 1)	Make payment by BANK TRANSFER to account No. 290-0033837-05 SCS Europe BVBA, SOCIETE GENERALE DE BANQUE, Branch Office Ghent Centre, Kouter 6, B-9000 Ghent, Belgium MENTION YOUR NAME and Euromedia'96
[ ] 2)	Or pay by CHEQUE and send it to SCS European Office, European Simulation Office, University of Ghent, Coupure Links 653, B-9000, Ghent, Belgium.
[ ] 3)	Or pay by CREDIT CARD and fill in the information below:
	Charge my (tick one): []Visa [] Euro/Mastercard [] American Express []Diners CARD NO: __ __ __ __ : __ __ __ __ : __ __ __ __ : __ __ __ __ EXP.DATE: __ __ / __ __
	Authorizing Signature:

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 European Office, European Simulation Office, University of Ghent, Coupure Links 653, B-9000, Ghent, Belgium.

FOR OFFICE USE ONLY:

Paper Code:

Number of Pages:

Date entered on Registration File:

Status Entered:

Reg Memo:

AF Memo: