The National SBIR Conference
Hyatt Regency Orange County Hotel * Anaheim, CA
March 11–14, 2002
On-Site Registration Form


Badge Name: (if different)___________________________________________________________________________





Conference Registration Fees: Workshops below require a SBIR Conference registration.
SBIR Full Conference Registration $375
 Selection Optional Workshops—Additional Fee Required Fee
   Workshop #1: Phase II Proposal Preparation Workshop
   (Thursday, March 14, 12:30pm-5:00pm—Includes Lunch)
   Workshop #2: Phase III Commercialization—Business Beyond the Laboratory
   (Thursday, March 14, 1:00pm-5:00pm)
   Workshop #3: Intellectual Properties—Federal Laboratories and Small Businesses
   (Thursday, March 14, 1:00pm-5:00pm)
   Workshop #4: Designing Businesses to be Successful
   (Thursday, March 14, 1:00pm-5pm)
  Total Amount Due:  
Please indicate method of payment:

Credit Card: ____AMEX ____VISA ____MC

*VISA & Mastercard only: Please enter your CV code (the last 3 digits located on the signature panel on the back of your card). CV Code:______________________
Card Number:_____________________________________________ Exp.:_______________________
Card Holder Name:____________________________________ Signature:_____________________________

Please Answer the Following Questions:
  1. ____Please indicate if you need special assistance to participate.
    ____Do you have special dietary needs? Explain:__________________________________________

  2. Check if you are a past: ___ SBIR Phase I Winner ___ SBIR Phase II Award Winner

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