GAME-ON 2001 -- Electronic Registration Form

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LONDON, NOVEMBER 30 - DECEMBER 1, 2002

ELECTRONIC REGISTRATION FORM

Please note: This form does NOT work with Internet Explorer 3.02 or lower.
It does work fine with all versions of Netscape and other versions of Internet Explorer

First Name:
Surname:
Occupation and/or Title:
Affiliation:
Mailing Address:
Zipcode:
City:
Country:
Telephone:
Fax:
E-mail:

Yes, I will attend the 2001 GAME-ON conference.

A. Conference Registration. (Fill in 1/2/3/4/5 and 6/7 if necessary) PRICES VALID TILL NOVEMBER 25TH

1. SCS Conference Member EURO 400
SCS member number:
2. Member of Sponsor or Affiliate Society EURO 400
Affiliation Society:	Eurosim JSST CASS CSSS HSS, LSS PSS TSS
3. Non-Member participant EURO 475
4. GIGNEWS participant EURO 425
5. Students who are not authors or a ONE DAY registration EURO 175
6. Extra Conference Dinner ticket for companion. EURO 40
7. Extra Conference Proceedings EURO 40
8. 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, 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'2001 (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 YET encrypted in this 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 Bvba,
European Simulation Office, Ghent University,
Coupure Links 653, B-9000 Ghent, Belgium
Phone: +32-9-2337790, Fax: +32-9-2234941