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ECEC 2008 |
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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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E-MAIL |
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DATE |
SIGNATURE |
PRICES VALID TILL APRIL 1ST. After April 1st, prices will be 10% higher.
REGISTRATION AND
PAYMENT CONFERENCE REGISTRATION (Check appropriate boxes) |
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1. [ ] EUROSIS member
EUR
485 Member Number:_____________________________ |
EUR ___________ |
2. [ ] Members of Sponsor
or Affiliate Society
EUR
485 Circle your affiliation: SISO |
EUR ___________ |
3. [ ] Non-Member Participant EUR 545 | EUR ___________ |
4. [ ] Students, who are not authors but who wish to attend the conference, or ONE DAY PARTICIPANTS pay:EUR 300 | EUR ___________ |
(Above registration fees include, one copy of the PROCEEDINGS, all midday meals, cocktail, refreshments, coffees�and social program,) One Day Participants and Non-Author Students cannot participate in the conference dinner. | EUR |
5. [ ] Conference Dinner Ticket for Companion EUR 50 | EUR ___________ |
6. [ ] Extra Conference Proceedings EUR 25 | EUR ___________ |
VAT Number if applicable: _______________________________ | |
TOTAL AMOUNT DUE | EUR ___________ |
ADD BANK CHARGE of EUR 15 in case you pay by BANK or CHEQUE. | EUR ___________ |
TOTAL AMOUNT REMITTED | EUR ___________ |
[ ] 1) |
Make payment by BANK TRANSFER to account No. 001-4081477-84 EUROPEAN TECHNOLOGY INSTITUTE, ETI Bvba, FORTIS BANK, Branch Office Ghent Centre, Zonnestraat , B-9000 Ghent, Belgium IBAN CODE: BE03 0014 0814 7784, SWIFT CODE: GEBABEBB : 001-4081477-84 MENTION YOUR NAME and ECEC'2008 |
[ ] 2) | Or pay by CHEQUE and send
it to Philippe Geril, EUROSIS-ETI, European Simulation Office, University of Ghent, Faculty of Engineering, Dept.of Industrial Management, Technologiepark 903, B-9052, Zwijnaarde-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: |
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Print Signature
in CAPITALS |
PURCHASE ORDERS ARE NOT ACCEPTED
MAIL REGISTRATION FORM AND PAYMENT FORM COPY (1) / CHEQUE (2) / CREDITCARD INFO (3)
TO:
Philippe Geril, EUROSIS-ETI,
European Simulation Office
Ghent University,
Faculty of Engineering, Dept.of Industrial Management,
Technologiepark 903 , B-9052, Zwijnaarde-Ghent, Belgium.
Phone: +32-9-264.55.09, Fax: +32-9-264.58.25
Page created by Philippe Geril . Last update
01-04-08.
Copyright ETI Bvba - EUROSIS - All Rights Reserved