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

Dr/Mr/Mrs/Ms:_____________________________________________________________________________________

Badge Name: (if different)___________________________________________________________________________

Company:________________________________________________________________________________________

City/State/Zip:_____________________________________________________________________________________

Phone:__________________________________________________Fax:_____________________________________

Email:___________________________________________________________________________________________
Selection SBIR Full Conference Registration  
 

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

 $375

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)
$175
 
Wednesday, Oct. 30
$125
 
Thursday, Oct. 31
$125
  Total Amount Due:  
 
Please indicate method of payment:
___Cash

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 
    Other:_____________    ________________________________

  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