Please return this completed form with your manuscript
Author Registration Closes November 15, 1996. 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.
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 | ||
| LAST | FIRST | M.I. |
| COMPANY OR AFFILIATION | ||
| Mailing address (tick one): [ ] HOME [ ] BUSINESS | ||
| STREET | ||
| CITY | ||
| ZIPCODE |
COUNTRY | |
| TELEPHONE |
FAX |
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| DATE | SIGNATURE | |
| 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 473 |
| 2. | If your registration is AFTER 15th of November: ADDITIONAL FEE
(Fees include all lunches, coffees, conference dinner and conference proceedings) | [ ] BF 2.000 [ ] ECU 56 |
| B. | Excess page fee
BF 2250 (ECU60) for each page over 8 (in case of extended paper) or for each page over 5 (in case of normal paper) | BF__________ |
| C. | Copying fee
BF 50 (ECU 1) per copy page (if 4 copies are not included with paper) | BF __________ |
| VAT Number if applicable: | ||
| TOTAL AMOUNT DUE | BF___________ | |
| ADD BANK CHARGE of BF 350 (9ECU) in case you pay by BANK or CHEQUE. | BF___________ | |
| TOTAL AMOUNT REMITTED | BF___________ | |
| [ ] 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'96 |
| [ ] 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:
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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: |