Euromedia'98
REGISTRATION FORM
January 5-7, 1998
Please return this completed form with
your manuscript
Author Registration Closes December 5, 1997. For a paper
to be printed in the Conference Proceedings, we must receive the
copyright form(s) and paid registration for at least one author
of each paper by that date. Each registration covers only one
paper
Author registrations will not be refunded, but may be
transferred to a designee who will present the paper at the
Conference. At-Conference registration fees are considerably
higher than those shown in Section A.
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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| DATE |
SIGNATURE |
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| A. | AUTHOR REGISTRATION | |
| 1. | BASIC
REGISTRATION FEE. Please, tick all boxes that apply: [ ] Author or presenter of a paper [ ] Chairman [ ] Speaker [ ] Panelist [ ] Session/Discussion Leader |
[
] BF 18.000 [ ] ECU 450 [ ] BP 315 |
| 2. | If
your registration is AFTER 5th of December: ADDITIONAL
FEE (Fees include all lunches, coffees, conference dinner and conference proceedings) |
[
] BF 2.000 [ ] ECU 50 [ ] BP 35 |
| B. | Excess
page fee BF 2500 (ECU 62, BP 44) for each page over 8 (in case of extended paper) or for each page over 5 (in case of regular paper) |
BF/ECU/BP __________ |
| C. | Copying
fee BF 50 (ECU 1, BP 1) per copy page (if 4 copies are not included with paper) |
BF/ECU/BP __________ |
| VAT Number if applicable: | ||
| TOTAL AMOUNT DUE | BF/ECU/BP ___________ | |
| ADD BANK CHARGE of BF 400 (10 ECU / 8 BP) in case you pay by BANK or CHEQUE. | BF/ECU/BP ___________ | |
| TOTAL AMOUNT REMITTED | BF/ECU/BP ___________ | |
| [ ] 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 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: SCS European Office, European
Simulation Office, University of Ghent, Coupure Links 653,
B-9000, Ghent, Belgium.
FOR OFFICE USE ONLY:
| Paper Code: |
| Number of Pages: |
| Date entered on Registration File: |
| Status Entered: |
| Reg Memo: |
| AF Memo: |