GAME'ON 2005 -- Fax/Mail Registration Form

GAME'ON 2005
Leicester, United Kingdom
24-25 November 2005
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
E-MAIL
DATE	SIGNATURE

PRICES VALID TILL NOVEMBER 20TH. After November 20th, prices will be € 50 higher.

REGISTRATION AND PAYMENT A.CONFERENCE REGISTRATION (Check appropriate boxes)
1. [ ] EUROSIS member € 375 Member Number:_____________________________	€ ___________
2. [ ] Members of Sponsor or Affiliate Society € 375 Circle your affiliation: SISO	€ ___________
3. [ ] Non-Member Participant € 435	€ ___________
4. [ ] Students, who are not authors but who wish to attend the conference, or ONE DAY PARTICIPANTS pay: € 295	€ ___________
(Above registration fees include, one copy of the PROCEEDINGS, all midday meals, cocktail, refreshments, coffees and social program, except for students and ONE DAY PARTICIPANTS where the Conference Proceedings are NOT INCLUDED.)
5. [ ] Conference Dinner Ticket for Companion € 50	€ ___________
6. [ ] Extra Conference Proceedings € 50	€ ___________
VAT Number if applicable: _______________________________
TOTAL AMOUNT DUE	€ ___________
ADD BANK CHARGE of 10 EUR in case you pay by BANK or CHEQUE.	€ ___________
TOTAL AMOUNT REMITTED	€ ___________

[ ] 1)	I will make payment by BANK TRANSFER to account No. 001-4081477-84 European Technology Institute, ETI Bvba, FORTIS BANK, Branch Office Ghent Centre, Zonnestraat 2, B-9000 Ghent, Belgium IBAN IBAN CODE: BE03 0014 0814 7784, SWIFT CODE: GEBABEBB : 001-4081477-84 MENTION YOUR NAME and GAMEON 2005 (make a print of this form so you know what you submitted) and ADD A COPY OF PAYMENT TO THIS FORM
[ ] 2)	I will pay by CHEQUE and send it to Philippe Geril, EUROSIS-ETI, European Simulation Office, Ghent University, Faculty of Engineering, Dept.of Industrial Management, Technologiepark 903 , B-9052, Zwijnaarde-Ghent, Belgium. (make a print of this form so you know what you submitted)
[ ] 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:
	Print 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, 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