GameOn logo

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

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


EUROSIS logo

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 485
Member Number:_____________________________
___________
2. [ ] Members of Sponsor or Affiliate Society  485
Circle your affiliation: SISO
___________
3. [ ] Non-Member Participant 535 ___________
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. [ ] Tutorial only Registration for students: 25 .for non students:  75 ___________
6. [ ] Conference Dinner Ticket for Companion   50 (indicate if you require [] vegetarian or [] hallal 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
___________
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 200
6
(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


Page created by Philippe Geril . Last update 13-09-06.
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