Attch 1 DETER Virtual Industry Day Registration Form_2022.pdf

CUI

This form contains Controlled Unclassified Information (CUI) which must be protected under the Freedom of Information Act (5 U.S.C. 552) and/or the Privacy Act of 1974 (5 U.S.C. 552a). Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in disciplinary action, criminal and/or civil penalties. Further distribution is prohibited without the approval of the author of this message unless the recipient has a need to know in the performance of official duties. If you have received this form in error, please notify the sender and delete all copies of this form.

Air Force Research Laboratory Directed Energy Directorate DETER Virtual Industry Day

Registration Form 14 April 2022

10:00 am-12:00 pm

First Name

Middle Name

Last Name

Email Address

Company/University Name

Address

City State Zip Code

Phone Number

Cage Code (Vendor)

Small Business Large Business

Please confirm your organization has an active DD2345 (Please provide copy)

Yes No

*All attendees must be US Citizens

*No more than two people per firm will be allowed to attend the Virtual BFI. Per Firm is further defined as division/subsection of each company/university.

University/Non-Profit