| 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
10/07/03 |
After
10/07/03 |
| |
Full Conference |
$350 |
$425 |
| |
I will attend Welcome Reception on Monday (Full & Tuesday Conference Attendees Only)
|
Free |
| |
Tuesday, October 28, 2003 (Includes Welcome Reception on Monday)
|
$225 |
| |
Wednesday, October 29, 2003
|
$150 |
| |
Thursday, October 30, 2003
|
$75 |
| Optional WorkshopsAdditional Fee Required |
FEE |
| |
Workshop A: Proposal Preparation, Phase I
Monday, October 27, 7:30am-4:30pmIncludes Continental Breakfast, Lunch & Materials. |
$95 |
| |
Workshop B: Proposal Preparation, Phase II
Thursday, October 30, 12:30pm - 4:30pmIncludes Lunch and Materials. |
$75 |
| |
Workshop C: Basic Accounting for Government Contracts
Thursday, October 30, 1:00pm-4:00pm |
$45 |
| Bonus Sessions |
|
| |
Bonus Session #1: Compliance Issues
Thursday, October 30, 2003, 1:00pm-2:30pm |
FREE |
| |
Bonus Session #2: Electronic Submission
Thursday, October 30, 2003, 1:00pm-2:30pm |
FREE |
| Total Amount Due: |
|
|
Networking Area One-On-One TablesAdditional Fee Required
If you are interested in Networking Area One-On-One tables, please check the appropriate boxes below and a representative from the SBIR Conference Center will contact you. |
| I am interested in Networking Area One-On-One Tables (Fee: $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:________________________ |
| |
CANCELLATION POLICY:
Registrations are transferable when requested in writing. All cancellations or refund requests must be made in writing and faxed or mailed to the SBIR Conference Center. Cancellations received by October 7, 2003, will be refunded less a $50 processing fee. NO REFUNDS will be given for cancellations received after October 7, 2003, or for No Shows. Substitutions to original registrants can be made upon presentation of written authorization by the original registrant.
Please initial below. Your registration will NOT be accepted without your acknowledgement of cancellation policy.
_______I have read, understand, and agree to the terms of the cancellation policy above. |
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:
___BioTech___Communications ___Computers ___Electronics ___Energy ___Environmental Tech
Information Technologies ___Life Sciences ___Materials ___Mechanics ___Optics/Photonics
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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