National Fall SBIR/STTR Conference
Sheraton Burlington Hotel & Conference Center
Burlington, VT
October 28-31, 2002
On-site Registration Form


Badge Name: (if different)___________________________________________________________________________





Selection SBIR Full Conference Registration  

Full Conference
SBIR Conference registration includes all sessions, materials, meals, refreshments, and activities during regular conference hours.


One Day Registration Options:
All one day registrations include conference materials, all sessions, events and meals of the day.

Tuesday, Oct. 29
(Includes Monday Welcome Reception)
Wednesday, Oct. 30
Thursday, Oct. 31
  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. Number of Employees at your Company Location:
    ___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 

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

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


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Updated 10/16/02