Cubesat

2013 Workshop Registration Form

Please make sure you fill out all required fields before submitting.

Required *

Full Name *

Organization *

Identification * Industry/Faculty Student

E-mail *

Dates Attending *

To select multiple days, please hold the Ctrl key and click on each day.

Address 1 *

Street Address

Address 2

City/State/Zip *

Country *

Citizenship *

Please enter the country/countries of which you hold citizenship.

T-shirt Size * Small Medium Large X-Large 2X-Large

Would you like your name to be included on the Attendee Roster? * Yes No

Would you like your email to be included on the Attendee Roster? * Yes No

An Attendee Roster with names and emails will be published and available to the workshop attendees following the event.

Attending the Opening Banquet? * Yes No

The Opening Banquet will be held on the night of Wednesday, April 24, 2013.

Meal Selection * Non-Vegetarian Vegetarian

Special Dietary Needs

If you have any special dietary needs (i.e. vegetarian, vegan, gluten-free, etc.), please specify them here.

Additional Banquet Guests?

How many guests are you planning to have attend the banquet with you (guests are $50 per person)?

Guest Meal Selection

If you have indicated additional banquet guests, please record their desired type of meal here (non-vegetarian or vegetarian).

ITAR agreement * Agree Disagree

By selecting "Agree" you are agreeing that you have read and will abide by all ITAR regulations detailed here.

If you are paying for others beside yourself, please provide their names here.

If you are paying for others, please provide the name that will be on the credit card used for the registration fee.

If you are paying for others, please remember that a registration form needs to be filled out for each member.

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