ESM'99
Warsaw, Poland, June 1-4, 1999
ELECTRONIC REPLY FORM

(or use the fax/mail form)

ELECTRONIC REPLY 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 Internet Explorer 4 & 5
First Name:
Surname:
Occupation and/or Title:
Affiliation:
Mailing Address:
Zipcode:
City:
Country:
Telephone:
Fax:
E-mail:

Yes, I will attend the 1999 ESM conference.

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

(THESE PRE-CONFERENCE REGISTRATION PRICES ARE VALID TILL APRIL 30)

1. SCS Conference Member
EURO 425
SCS member number:
2. Member of Sponsor or Affiliate Society
EURO 425
Affiliation Society: Eurosim JSST CASS CSSS
HSS, LSS PSS TSS
3. Non-Member participant
EURO 526
4. Students who are not authors or a ONE DAY registration
EURO 265
5. Polish Participant
EURO 231

6. Polish Student
EURO 40

7. ONE DAY registration for Polish Participants ONLY
EURO 120

8. Extra Conference Dinner ticket
for companion. EURO 40

9. Add bank charge if necessary
when paying by bank transfer or cheque
EURO 10
TOTAL AMOUNT TO PAY IN EURO


B. PAYMENT INFORMATION

I will make payment by BANK TRANSFER to account No. 290-0033837-05 SCS Europe BVBA, GENERALE BANK, Branch Office Ghent Centre, Kouter 6, B-9000 Ghent, Belgium MENTION YOUR NAME and ESM'99 (make a print of this form so you know what you submitted)
I will pay by CHEQUE and send it to 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 SCS Europe Office 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:
SCS Europe Office, 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