EUROMEDIA 2001 |
Please legibly print or type and fill out completely.
FIRST NAME |
LAST NAME |
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 |
REGISTRATION AND
PAYMENT A.CONFERENCE REGISTRATION (Check appropriate boxes) PRICES VALID TILL MARCH 25TH |
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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 Euromedia'2001 |
[ ] 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: __ __ / __ __ |
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Authorizing Signature: |
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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:
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
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