EUROMEDIA 2000 -- Fax/Mail Registration Form

EUROMEDIA 2000
Antwerp, Belgium, 8-10 May 2000
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
DATE	SIGNATURE

REGISTRATION AND PAYMENT A.CONFERENCE REGISTRATION (Check appropriate boxes)
1. [ ] SCS member 450 EURO Member Number:_____________________________	EURO ___________
2. [ ] Members of Sponsor or Affiliate Society 450 EURO Circle your affiliation: EUROSIM JSST CASS CSSS HSS LSS PSS TSS	EURO ___________
3. [ ] Non-Member Participant 500 EURO	EURO ___________
4. [ ] Students, who are not authors but who wish to attend the conference, or ONE DAY PARTICIPANTS pay: 250 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.)
5. [ ] Conference Dinner Ticket for Companion EURO 40	EURO ___________
6. [ ] 21% VAT (has to be included in the registration fee)	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 PLUS VAT	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 MENTION YOUR NAME and Euromedia'2000
[ ] 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:

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,
European Simulation Office, University of Ghent,
Coupure Links 653, B-9000 Ghent, Belgium
Phone: +32-9-2337790, Fax: +32-9-2234941