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MESM'2000

Registration Form

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FAX/MAIL REGISTRATION FORM (or use the electronic form)


Please legibly print or type and fill out completely.

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

 

REGISTRATION AND PAYMENT (PRICES VALID TILL AUGUST 15TH)
A.CONFERENCE REGISTRATION
(Check appropriate boxes)
1. [ ] SCS member BF $ 450 / EURO 450
Member Number:_____________________________
$/EURO
___________
2. [ ] Members of Sponsor or Affiliate Society
$ 450 / EURO 450
Circle your affiliation: EUROSIM JSST CASS CSSS HSS LSS PSS TSS
$/EURO
___________
3. [ ] Jordanian Participant
$ 185 / EURO 185
$/EURO
___________
4. [ ] Arab Participant
$ 200 / EURO 200
$/EURO
___________
5. [ ] Non-Member Participant
$ 475 / EURO 475
$/EURO
___________
6. [ ] For registration AFTER August 15, add
$ 50 / EURO 50
$/EURO
___________
7. [ ] Students, who are not authors but who wish to attend the conference pay:
$ 125 / EURO 125
$/EURO
___________
(Above registration fees include, one copy of the PROCEEDINGS, all midday meals, cocktail, refreshments, coffees and social program, except for students where the Conference Proceedings are NOT INCLUDED.)  
8. [ ] Conference Dinner Ticket for Companion
$ 40 / EURO 40
$/EURO
___________
VAT Number if applicable: _______________________________
TOTAL AMOUNT DUE $/EURO
___________
ADD BANK CHARGE of  ($ 15 / EURO 15) 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 MESM'2000
[ ] 2) Or pay by CHEQUEand send it to Philippe Geril, SCS European Office, European Simulation Office, University of Ghent, Coupure Links 653, B-9000, Ghent, Belgium.
[ ] 3) Or pay by CREDIT CARDand 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:
Philippe Geril, 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 Philippe Geril. Last update 03-02-03.
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