Euromedia logo

EUROMEDIA 99
Munich, Germany, 26-28 March 1999
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.
First Name:
Surname:
Occupation and/or Title:
Affiliation:
Mailing Address:
Zipcode:
City:
Country:
Telephone:
Fax:
E-mail:

Yes, I will attend the 1999 EuroMedia conference.

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

1. SCS Conference Member
EURO 450
SCS member number:
2. Member of Sponsor or Affiliate Society
EURO 450
Affiliation Society: Eurosim JSST CASS CSSS
HSS, LSS PSS TSS
3. Non-Member participant
EURO 500
4. Students who are not authors or a ONE DAY registration
EURO 250
5. Extra Conference Dinner ticket
for companion. EURO 40
6. Add bank charge if necessary
when paying by bank transfer or cheque
EURO 10
TOTAL AMOUNT TO PAY IN 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 EUROMEDIA'99 (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:
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