GameOn logo

GAME'ON 2006
Braunschweig, Germany,
November 29 - December 1, 2006
ELECTRONIC REPLY FORM

(or use the fax/mail form)

 

EUROSIS logo

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

Yes, I will attend the 2006 GAME'ON conference.

A. Conference Registration. (Fill in 1/2/3/4 and 5/6/7 if necessary) - PRE-CONFERENCE PRICES VALID TILL NOVEMBER 20TH. After November 20th, prices will be 50 higher.

1. EUROSIS Conference Member
485
EUROSIS member number:
2. Member of Sponsor or Affiliate Society
485
Affiliation Society: none SISO
3. Non-Member participant
535
4. Students who are NOT authors or a ONE DAY registration
295
5. Tutorial Only registration
for students: 25 .for non students:  75
6. Extra Conference Dinner ticket
for companion: 50
(indicate if you require vegetarian (V) or hallal (H) food)
7. Extra Conference Proceedings
40
8. I will not be able to attend the conference but would like to order a copy of the Proceedings
50 plus 15% shipping costs and VAT if applicable
9. Add bank charge if necessary
when paying by bank transfer or cheque
15
TOTAL AMOUNT TO PAY IN


B. PAYMENT INFORMATION

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 200
6
(make a print of this form so you know what you submitted) and ADD A COPY OF PAYMENT TO THIS FORM
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)
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 encrypted YET during transfer. If this is a problem: fax the credit card information separately, or discuss the payment information with Philippe Geril by phone or by e-mail.
Type of card
Card no
Cardholder name
Exp.Date

If submit fails, you can also print this information and send / fax 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.
Phone: +32-9-264.55.09, Fax: +32-9-264.58.25


Page created by Philippe Geril . Last update 13-09-06.
Copyright ETI Bvba - EUROSIS - ISA - All Rights Reserved