MICS ID2 Registration Form 1.1_distributed.pdf

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Missile Defense Agency Information Technology Collaboration Services (MICS)
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H95001-10-R-0001
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MICS Industry Days 2 Registration Form

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SUBMISSION DEADLINE: February 22, 2012

MDA IT Collaboration Services (MICS) 2nd Industry Days Registration Form

Missile Defense Integration & Operations Center (MDIOC) Schriever AFB, Colorado

March 6 - 9, 2012

Company _______________________________________________________________________________ Address _______________________________________________________________________________

City _________________________________ State _____________ Zip ___________________ Cage Code ________________

March 6 & 7 – Government Briefings & Site Visit each company is limited to 4 attendees

REQUIRED FIELD

March 7, 8 & 9 – One-on-One Meetings companies are limited to 1 meeting

Would you like to participate in a One-on-One Q&A session with MDA representatives? YES NO

Instructions/Notes Complete registration information above, one entry per company Email completed form to MICS-IndustryDays@mda.mil Deadline for submission of form is February 22, 2012 NO EXCEPTIONS Upon receipt of registration form, an information package will be emailed to your designated Company POC Each attendee must have a SECRET clearance or higher; instructions for clearance submission will be in the information package. Deadline for clearance submission is February 27, 2012 NO EXCEPTIONS One-on-one meetings will be limited to 30 minutes and scheduled in the order that requests are received Only 1 one-on-one meeting is allowed per company over the 1st and 2nd Industry Days

FOR MDA USE ONLY – Cage Code Verification Facility Acceptable? Comments

Yes No verified by

US

Name Title Phone Email Citizen?

Designated Company POC initiator:MICS-IndustryDays@mda.mil;wfState:distributed;wfType:email;workflowId:a6606ff3b1415643bf40fceba2b6cf14

Company_Name:
Company_Address_1:
Company_Address_2:
Company_Address_3:
Company_City:
Company_State:
Company_Zip:
Company_Cage_Code:
Name_1:
Title_1:
Phone_1:
email_1:
Is this person a US Citizen?:
name_2:
title_2:
phone_2:
email_2:
Is this person a US Citizen?:
name_3:
title_3:
phone_3:
email_3:
Is this person a US Citizen?:
name_4:
title_4:
phone_4:
email_4:
Is this person a US Citizen?:
Select 1:
Explain if facility is not acceptable:
Indicate acceptability and enter comments before signing:
ButtonField1:

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