SBIR Fax/Mail Back Form

	The National SBIR/STTR Conference Hyatt Regency Albuquerque Hotel Albuquerque, NM March 11 - 14, 2003
	Print & Fax/Mail Back Registration Form

Dr/Mr/Mrs/Ms:_____________________________________________________________________________________

Badge Name: (if different)___________________________________________________________________________

Company:________________________________________________________________________________________

City/State/Zip:_____________________________________________________________________________________

Phone:__________________________________________________Fax:_____________________________________

Email:___________________________________________________________________________________________

Selection	SBIR/STTR Conference Registration Options	Register By 02/20/03	After 02/20/03
	Full Conference	$350	$400
	Wednesday, March 12, 2003 (Includes Tuesday Welcome Reception)	$175
	Thursday, March 13, 2003	$150
	Friday, March 14, 2003	$75
	Optional WorkshopsAdditional Fee Required	Fee
	Phase I Proposal Preparation Workshop Tuesday, March 11, 7:30am-4:30pmIncludes Continental Breakfast, Lunch & Materials.	$75
	Workshop #1: Proposal Preparation Workshop, Phase II Friday, March 14, 12:15pm - 4:00pmIncludes a Box Lunch & Materials.	$60
	Workshop #2: Basic Accounting for Government Contracts Friday, March 14, 1:00pm-3:00pm	$35
	Workshop #3: Three Pieces of the Puzzle! Friday, March 14, 1:00pm-3:00pm	$35
	Workshop #4: Winning Phase III SBIR Awards/Challenging "Bundled" Contracts Friday, March 14, 1:00pm-4:00pm	$75
	Total Amount Due:

Selection	Exhibits & One-On-One TablesAdditional Fee Required If you are interested in exhibit space or one-on-one tables, please check the appropriate boxes below and a representative from the SBIR Conference Center will contact you.	Fee
	I am interested in 10'x 10' Exhibit Space	$100/space
	I am interested in Table Top Exhibit Space	$75/space
	I am interested in One-On-One Tables	$50 x # of tables

Total Registration/Additional Workshop Fees: $

Check - Payable to SBIR Conferences

Credit Card: _____VISA _____Mastercard _____American Express

Note: For 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:

Number of Employees at your Company Location:
___2-5 ___6-19 ___20-49 ___50-99 ___100-249 ___250-499 ___500+
Which of the following describes your main area of interest? Check ONE:
___Communications ___Computers ___Electronics ___Energy ___Optics/Photonics
___Environmental Tech ___Life Sciences ___Materials ___Mechanics
Other:_____________________________________________
____Please indicate if you need special assistance to participate.
____Do you have special dietary needs? Explain:__________________________________________
Check if you are a past: ___ SBIR Phase I Winner ___ SBIR Phase II Award Winner

Please check those agencies you have an SBIR/STTR award with:

____Department of Agriculture
Department of Commerce:
____NIST
____NOAA
Department of Defense:
____Army
____Air Force
____DARPA
____Missile Defense Agency
____Navy
____SOCOM

____Department of Education
____Department of Energy
____Department of Health & Human Services
____Department of Transportation
____Environmental Protection Agency
____NASA
____National Science Foundation

Questions? Call the SBIR Conference Center at .

Return completed forms to:
SBIR Conference Center
P.O. Box 2890
Sequim, WA 98382
or
FAX:

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