Registration

Because this meeting is being held on the ORNL reservation, badges will be required for admitance. To have time for the mandatory security procedures involved in badging, it is important for you to provide the information requested on the form below as early as possible.

There is a registration fee of $75 that may be paid onsite by cash, check or credit card. A continental breakfast will be provided all three days, lunch the first two days, and a banquet Friday night. A block of rooms at $65/night has been reserved at the DoubleTree in Oak Ridge under the group "Frontiers in Tribology" (cutoff date for the block is 1/18/04). Attendees are responsible for making their own housing reservations.

Full Name (no initials)
(First, Middle, Last):
Gender: Male Female
E-mail:

Current Address
Street or PO Box:
City:
State: Zip/Postal Code:
Country:

Phone Numbers
School/Work: Fax:
Home: Fax:

Education
Highest Degree: University:
Year Attained: Major:

Employer Address
Employer Name:
Street or PO Box:
City:
State: Zip/Postal Code:
Country:

What is your position?

Citizenship/Identity Information
Social Security Number:
Date of Birth:
US Citizen or US Permanent Residence Alien? Yes No

Country of Birth: City of Birth:
Country of Citizenship:

If you are a US Permanent Resident Alien (PRA), please provide:
PRA Number: PRA Expiration date:

If not a U.S. Citizen and not Permanent Resident Alien, please also provide:
VISA type (e.g., J-1): VISA number: VISA Expiration date:
   Passport number: Passport Expiration date:

Please indicate any special dietary needs/restrictions

Don't forget to click the "Send" button!

Successful submission will take you back to the Workshop home page.


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URL http://www.csm.ornl.gov/meetings/FiTAS/FiTASreg.html
Updated: Thursday, 15-Jan-2004 10:37:19 EST
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