Game-On 2001 -- Fax/Mail Registration Form

GAME-ON 2001
London, United Kingdom,
30 November-1 December 2001
FAX/MAIL REGISTRATION FORM
(or use the electronic form) LINKED BUT NOT YET ON THE SECURE SERVER

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
DATE	SIGNATURE

PRICES VALID TILL NOVEMBER 25TH.

REGISTRATION AND PAYMENT A.CONFERENCE REGISTRATION (Check appropriate boxes)
1. [ ] SCS member 400 EURO Member Number:_____________________________	EURO ___________
2. [ ] Members of Sponsor or Affiliate Society 400 EURO Circle your affiliation: EUROSIM JSST LSS PSS TSS	EURO ___________
3. [ ] Non-Member Participant 475 EURO	EURO ___________
4. [ ] GiGNEWS Participant 425 EURO	EURO ___________
5. [ ] Students, who are not authors but who wish to attend the conference, pay: 100 EURO	EURO ___________
(Above registration fees include, TUTORIALS, one copy of the PROCEEDINGS, all midday meals, cocktail, refreshments, coffees and social program.)
6. [ ] Conference Dinner Ticket for Companion EURO 40	EURO ___________
VAT Number if applicable: _______________________________
TOTAL AMOUNT DUE	EURO ___________
ADD BANK CHARGE of 10 EURO in case you pay by BANK 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 GAME-ON 2001
[ ] 2)	Or pay by CHEQUE and send it to SCS Europe, Ghent University, 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:	PRINT 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:
SCS Europe Bvba,
Ghent University,
Coupure Links 653, B-9000 Ghent, Belgium
Phone: +32-9-2337790, Fax: +32-9-2234941