ECEC 2001
Valencia, Spain, 18-20 April 2001
FAX/MAIL REGISTRATION FORM
(or use the electronic 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
 
E-MAIL
 
DATE
 		 SIGNATURE
 

PRICES VALID TILL MARCH 25TH. After March 25th, prices will be 10% higher.

REGISTRATION AND PAYMENT
A.CONFERENCE REGISTRATION (Check appropriate boxes)
1. [ ] SCS member 475 EURO
Member Number:_____________________________ 		EURO
___________
2. [ ] Members of Sponsor or Affiliate Society
475 EURO
Circle your affiliation: EUROSIM JSST CASS CSSS HSS LSS PSS TSS 		EURO
___________
3. [ ] Non-Member Participant
525 EURO		 EURO
___________
4. [ ] Students, who are not authors but who wish to attend the conference, or ONE DAY PARTICIPANTS pay:
275 EURO		 EURO
___________
(Above registration fees include, one copy of the PROCEEDINGS, all midday meals, cocktail, refreshments, coffees and social program, except for students and ONE DAY PARTICIPANTS where the Conference Proceedings are NOT INCLUDED.)  
5. [ ] Conference Dinner Ticket for Companion
EURO 50		 EURO
6. [ ] Extra Conference Proceedings
EURO 75		 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 ECEC'2001
[ ] 2) Or pay by CHEQUE and send it to Philippe Geril, 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:
  
Print 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:
Philippe Geril, The Society for Computer Simulation International,
SCS Europe Bvba, 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 Philippe Geril