MESM'99
Mail/Fax Registration Form
- Venue and Conference Location
- Social Programme
- Hotel Information
- Mail/Fax Registration Form
- Electronic Registration Form
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MESM'99 Mail/Fax Registration Form |
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Please legibly print or type and fill out completely.
| NAME |
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| LAST |
FIRST |
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 A.CONFERENCE REGISTRATION (Check appropriate boxes) |
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| 1. [ ] SCS member BF 12.000 / $ 325 /
EURO 300 Member Number:_____________________________ |
BF/$/EURO ___________ |
| 2. [ ] Members of Sponsor or Affiliate
Society BF 12.000 / $ 325 / EURO 300 Circle your affiliation: EUROSIM JSST CASS CSSS HSS LSS PSS TSS |
BF/$/EURO ___________ |
| 3. [ ]
Jordanian Participant BF 7.500 / $ 320 / EURO 185 |
BF/$/EURO ___________ |
| 4. [ ]
Non-Member Participant BF 15.000 / $ 425 / EURO 370 |
BF/$/EURO ___________ |
| 5. [ ] For registration AFTER February
15, add BF 2.000 / $ 60 / EURO 50 |
BF/$/EURO ___________ |
| 6. [ ] Students, who are not
authors but who wish to attend the conference
pay: BF 4.500 / $ 120 / EURO 125 |
BF/$/EURO ___________ |
| (Above registration fees include, TUTORIALS, one copy of the PROCEEDINGS, all midday meals, cocktail, refreshments, coffees and social program, except for students where the Conference Proceedings are NOT INCLUDED.) | |
| 7. [ ]
Conference Dinner Ticket for Companion BF 1300 / $ 40 / EURO 33 |
BF/$/EURO ___________ |
| VAT Number if applicable: _______________________________ | |
| TOTAL AMOUNT DUE | BF/$/EURO ___________ |
| ADD BANK CHARGE of BF 400 ($ 15 / EURO 10) in case you pay by BANK or CHEQUE. | BF/$/EURO ___________ |
| TOTAL AMOUNT REMITTED | BF/$/EURO ___________ |
[ ] 1) |
Make payment by BANK TRANSFER to account No. 290-0033837-05 SCS Europe BVBA, GENERALE DE BANK, Branch Office Ghent Centre, Kouter 6, B-9000 Ghent, Belgium MENTION YOUR NAME and MESM'98 |
| [ ] 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: |
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
This page last
modified 03-02-03 by Alexander Verbraeck, Delft University of Technology / SCS
Europe