Warsaw, Poland, June 1-4, 1999
FAX/MAIL REPLY FORM
|
ESM'99 Warsaw, Poland, June 1-4, 1999 FAX/MAIL REPLY FORM |
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 |
|
(THESE PRE-CONFERENCE REGISTRATION PRICES ARE VALID TILL APRIL 30)
| REGISTRATION AND PAYMENT A.CONFERENCE REGISTRATION (Check appropriate boxes) |
|
| 1. [ ] SCS member 425 EURO Member Number:_____________________________ |
EURO ___________ |
| 2. [ ] Members of Sponsor or Affiliate
Society 425 EURO Circle your affiliation: EUROSIM JSST CASS CSSS HSS LSS PSS TSS |
EURO ___________ |
| 3. [ ] Non-Member Participant 526 EURO |
EURO ___________ |
| 4. [ ] Students, who are not
authors but who wish to attend the conference, or
ONE DAY PARTICIPANTS pay: 265 EURO |
EURO ___________ |
| 5. [ ]
Polish Participant 265 EURO |
EURO ___________ |
| 6. [ ]
Polish Student 40 EURO |
EURO ___________ |
| 7. [ ]
ONE DAY REGISTRATION for Polish Participants ONLY 120 EURO |
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.) | |
| 8. [ ]
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, GENERALE BANK, Branch Office Ghent Centre, Kouter 6, B-9000 Ghent, Belgium MENTION YOUR NAME and ESM'99 |
| [ ] 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:
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