MESM99

Electronic Registration Form

(or use the fax registration form)
ELECTRONIC REPLY FORM
Please note: This form does NOT work with Internet Explorer 3.02 or lower.
It does work fine with all versions of Netscape. We will do testing with IE 4.0.
Surname:
First Name:
Occupation and/or Title:
Affiliation:
Mailing Address:
Zipcode:
City:
Country:
Telephone:
Fax:
E-mail:

Yes, I will attend the 1999 MESM workshop in Amman, Jordan.

A. Conference Registration. (Fill in 1/2/3/5 and 4/6/7 if necessary)

1. SCS Conference Member
BF 12.000 / $ 325 / EURO 300
SCS member number:
2. Member of Sponsor or Affiliate Society
BF 12.000 / $ 325 / EURO 300
Affiliation Society: Eurosim, JSST, CASS, CSSS, HSS, LSS, PSS, TSS
3. Jordanian participant
BF 7.500 / $ 200 / EURO 185
4. Non-Member participant
BF 15.000 / $ 425 / EURO 370
5. Late registration surcharge
after February 15,
add: BF 2.000 / $ 60 / EURO 50
6. Students who are not authors
BF 4.500 /$ 120 / EURO 125
7. Extra Conference Dinner ticket
for companion. BF 1300 / $ 40 / EURO 33
8. Add bank charge if necessary
when paying by bank transfer or cheque
BF 400 / $ 15 / EURO 10
TOTAL AMOUNT TO PAY (BF/BP/EURO)


B. PAYMENT INFORMATION

I will make payment by BANK TRANSFER to account No. 290-0033837-05 SCS Europe BVBA, GENERALE BANK, Branch Office Ghent Centre, Kouter 6, B-9000 Ghent, Belgium MENTION YOUR NAME and MESM'99 (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 encrypted in the 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, 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