EUROMEDIA 2008
Porto, Portugal, 9-11 April  2008
FAX/MAIL REGISTRATION 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 APRIL 1ST. After April 1st, prices will be 10% higher.

REGISTRATION AND PAYMENT
CONFERENCE REGISTRATION
(Check appropriate boxes)
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´┐Żand 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 35 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 EUROMEDIA'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: __ __ / __ __

Authorizing Signature:
 
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.
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