National SBIR Fall Conference
Rapid City, South Dakota * October 23 - 26, 2001
On-Site Registration Form

(You may staple your business card to form to save time)
Dr/Mr/Mrs/Ms:___________________________________________________________________________________________________
Company:_______________________________________________________________________________________________________
City/ST/Zip:______________________________________________________________________________________________________
Phone:___________________________________________________Fax:___________________________________________________
Email:__________________________________________________________________________________________________________
 
Conference Registration Fees:
$225.00
 
Optional Pre/Post Conference Workshops * Additional Fees Required
All workshops below REQUIRE an SBIR Conference Registration
Workshop Title
FEE
  Commercialization of University Research Results
Friday, October 26; 1:00pm		 $35.00
  Phase II Proposal Preparation Workshop
Friday, October 26; 12:30pm (Box Lunch included)		 $35.00

                  Total Amount Due: $ _______

Please Indicate Method of Payment:
_____Cash
_____Check (Payable to SBIR Conference Center)
Credit Card: ____AMEX ____VISA ____MC
Your Credit Card will show a charge from "SBIR Conferences"

Please Answer the Following Questions:
  1. Number of Employees at your Company Location:
    ___1 ___2-5 ___6-19 ___20-49 ___50-99 ___100-249 ___250-499 ___500+

  2. 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:_____________    ________________________________

  3. ____Please indicate if you need special assistance to participate.
    ____Have special dietary needs? Explain:__________________________________________

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