EUROMEDIA 98 -- Electronic Registration Form

EUROMEDIA 98
Leicester, UK, 5-6 January 1998
ELECTRONIC REPLY FORM
(or use the fax/mail 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 1998 EuroMedia conference.

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

1. SCS Conference Member BF 20.000 / ECU 500
SCS member number:
2. Member of Sponsor or Affiliate Society BF 20.000 / ECU 500
Affiliation Society:	Eurosim, JSST, CASS, CSSS, HSS, LSS, PSS, TSS
3. Non-Member participant BF 22.000 / ECU 550
4. Students who are not authors BF 9.000 / ECU 225
5. Extra Conference Dinner ticket for companion. BF 1.300 / ECU 33
6. Add bank charge if necessary when paying by bank transfer or cheque BF 400 / ECU 10
TOTAL AMOUNT TO PAY (BF/DM/ECU)

B. PAYMENT INFORMATION

I will 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 (make a print of this form so you know what you submitted)

I will pay by CHEQUE and send it to 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 SCS Europe Office 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:
SCS Europe Office, 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