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EUROMEDIA 99
Munich, Germany, 26-28 April 1999
FAX/MAIL REGISTRATION FORM
(
or use the electronic form)

Please legibly print or type and fill out completely.

FIRST NAME
 
LAST NAME
 
M.I.
 
COMPANY OR AFFILIATION
 
Mailing address (tick one): [ ] HOME [ ] BUSINESS
STREET
 
CITY
 
ZIPCODE
 
COUNTRY
 
TELEPHONE
 
FAX
 
DATE
 
SIGNATURE
 

 

REGISTRATION AND PAYMENT
A.CONFERENCE REGISTRATION (Check appropriate boxes)
1. [ ] SCS member 450 EURO
Member Number:_____________________________
EURO
___________
2. [ ] Members of Sponsor or Affiliate Society
450 EURO

Circle your affiliation: EUROSIM JSST CASS CSSS HSS LSS PSS TSS
EURO
___________
3. [ ] Non-Member Participant
500 EURO
EURO
___________
4. [ ] Students, who are not authors but who wish to attend the conference, or ONE DAY PARTICIPANTS pay:
250 EURO
EURO
___________
(Above registration fees include, TUTORIALS, one copy of the PROCEEDINGS, all midday meals, cocktail, refreshments, coffees and social program, except for students where the Conference Proceedings are NOT INCLUDED.)  
5. [ ] Conference Dinner Ticket for Companion
EURO 40
EURO
___________
VAT Number if applicable: _______________________________
TOTAL AMOUNT DUE EURO
___________
ADD BANK CHARGE of 10 EURO in case you pay by BANK or CHEQUE. EURO
___________
TOTAL AMOUNT REMITTED EURO
___________

[ ] 1)

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
[ ] 2) Or pay by CHEQUE and send it to 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:
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