ESS 2001 -- Electronic Registration Form

ESS'2001

MARSEILLE, OCTOBER 18-20, 2001

ELECTRONIC REGISTRATION 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 other versions of Internet Explorer

First Name:
Surname:
Occupation and/or Title:
Affiliation:
Mailing Address:
Zipcode:
City:
Country:
Telephone:
Fax:
E-mail:

Yes, I will attend the 2001 ESS conference.

A. Conference Registration. (Fill in 1/2/3/4 and 5/6 if necessary) PRICES VALID TILL OCTOBER 1ST

1. SCS Conference Member EURO 475
SCS member number:
2. Member of Sponsor or Affiliate Society EURO 475
Affiliation Society:	Eurosim JSST CASS CSSS HSS, LSS PSS TSS
3. Non-Member participant EURO 525
4. Students who are not authors or a ONE DAY registration EURO 250
5. Extra Conference Dinner ticket for companion. EURO 60
6. Extra Conference Proceedings EURO 125
7. 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, FORTIS BANK, Branch Office Ghent Centre, Kouter 6, B-9000 Ghent, Belgium IBAN CODE: BE96290003383705, SWIFT CODE: GEN: GEBABEBB-05A, MENTION YOUR NAME and ESS'2001 (make a print of this form so you know what you submitted)

I will 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. (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 YET encrypted in this e-mail. If this is a problem: fax the credit card information separately, or discuss the payment information with Philippe Geril 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:
Philippe Geril, SCS Europe Bvba,
European Simulation Office, Ghent University,
Coupure Links 653, B-9000 Ghent, Belgium
Phone: +32-9-2337790, Fax: +32-9-2234941