GAME-ON 2000 |
Please legibly print or type and fill out completely.
FIRST NAME |
LAST NAME |
M.I. |
COMPANY OR AFFILIATION |
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Mailing address (tick one): [ ] HOME [ ] BUSINESS | ||
STREET |
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CITY |
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ZIPCODE |
COUNTRY |
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TELEPHONE |
FAX |
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DATE |
SIGNATURE |
PRICES VALID TILL OCTOBER 30TH.
REGISTRATION AND
PAYMENT A.CONFERENCE REGISTRATION (Check appropriate boxes) |
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1. [ ] SCS member 400
EURO Member Number:_____________________________ |
EURO ___________ |
2. [ ] Members of Sponsor
or Affiliate Society 400 EURO Circle your affiliation: EUROSIM JSST LSS PSS TSS |
EURO ___________ |
3. [ ] Non-Member
Participant 475 EURO |
EURO ___________ |
4. [ ] Students, who
are not authors but who wish to attend the conference, pay: 100 EURO |
EURO ___________ |
(Above registration fees include, TUTORIALS, one copy of the PROCEEDINGS, all midday meals, cocktail, refreshments, coffees and social program.) | |
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, FORTIS BANK, Branch Office Ghent Centre, Kouter 6, B-9000 Ghent, Belgium IBAN CODE: BE96290003383705, SWIFT CODE: GEN: GEBABEBB-05A, MENTION YOUR NAME and GAME-ON 2000 |
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[ ] 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: __ __ / __ __ |
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Authorizing Signature: |
PRINT NAME: _________________________ |
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
Page created by SCS Europe Office. Last update 03-02-03
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