ESS'98
October 26-28,
1998
FAX/MAIL REGISTRATION FORM
(or use the electronic form)
|
ESS'98 |
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) |
|
| 1. [ ] SCS member BF 17.000 / £ 285 /
ECU 425 Member Number:_____________________________ |
BF/ECU ___________ |
| 2. [ ] Members of Sponsor or Affiliate
Society BF 17.000 / £ 285 / ECU 425 Circle your affiliation: EUROSIM JSST CASS CSSS HSS LSS PSS TSS |
BF/ECU ___________ |
| 3. [ ]
Non-Member Participant BF 19.000 / £ 320 / ECU 475 |
BF/ECU ___________ |
| 4. [ ] For registration AFTER September
15, add BF 2.000 / £ 35 / ECU 50 |
BF/ECU ___________ |
| 5. [ ] Students, who are not
authors but who wish to attend the conference
pay: BF 9.000 / £ 150 / ECU 225 |
BF/ECU ___________ |
| (Above registration fees include, TUTORIALS, one copy of the PROCEEDINGS-CD-Rom, all midday meals, cocktail, refreshments, coffees and social program, except for students where the Conference Proceedings are NOT INCLUDED.) | |
| 6. [ ]
Conference Dinner Ticket for Companion BF 1300 / £ 22 / ECU 33 |
BF/ECU ___________ |
| VAT Number if applicable: _______________________________ | |
| TOTAL AMOUNT DUE | BF/ECU ___________ |
| ADD BANK CHARGE of BF 400 (£ 7 / ECU 10) in case you pay by BANK or CHEQUE. | BF/ECU ___________ |
| TOTAL AMOUNT REMITTED | BF/ECU ___________ |
[ ] 1) |
Make payment by BANK TRANSFER to account No. 290-0033837-05 SCS Europe BVBA, SOCIETE GENERALE DE BANQUE, Branch Office Ghent Centre, Kouter 6, B-9000 Ghent, Belgium MENTION YOUR NAME and Euromedia'98 |
| [ ] 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