Registration_Form.pdf

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Attached to
N00014-16-R-0012 Industry Day Federal contract opportunity
Solicitation number
N00014-16-R-0012
Issued by
Department of the Navy Secretary of the Navy Office of Naval Research

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N00014-16-R-0012 Industry Day Registration Form

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REGISTRATION FORM

Office of Naval Research - EMC² LowRIDR Industry Day

May 10, 2016 (7:15 am Badge Office Check-in / 8:00 am Meeting Start) SPAWAR Systems Center Pacific - San Diego, CA

Please fill out this form and e-mail it to the following individuals (RSVP by 4/27/16):

Mr. Marcus Maurer, marcus.maurer@navy.mil Dr. Diana Arceo, diana.arceo@navy.mil

Ms. Shauna Koppel, shauna.koppel.ctr@navy.mil

COMPANY NAME

ATTENDEES (additional space on page 2):

1.) Full Name Last, First, MI

1.) e-mail address 1.) phone number

1.) Classified VR Sent? YES NO 1.) Permission to provide contact info to other attendees?

YES NO

2.) Full Name Last, First, MI

2.) e-mail address 2.) phone number

2.) Classified VR Sent? YES NO 2.) Permission to provide contact info to other attendees?

YES NO

3.) Full Name Last, First, MI

3.) e-mail address 3.) phone number

3.) Classified VR Sent? YES NO 3.) Permission to provide contact info to other attendees?

YES NO

Is your company interested in presenting a non-proprietary briefing to the attendees?

YES NO

If yes, a briefing must be provided to the individuals listed above by 4/27/16.

(**The Government will review these briefings for applicability and reserves the right to decide how much time, if any, each company will be given to present.)

**Additional meeting logistics (directions/parking/agenda/etc.) will be provided after your registration has been confirmed.**

ATTENDEES (continued):

Government reserves the right to limit the number of attendees per company if necessary due to space restrictions.

4.) Full Name Last, First, MI

4.) e-mail address 4.) phone number

4.) Classified VR Sent? YES NO 4.) Permission to provide contact info to other attendees?

YES NO

5.) Full Name Last, First, MI

5.) e-mail address 5.) phone number

5.) Classified VR Sent? YES NO 5.) Permission to provide contact info to other attendees?

YES NO

6.) Full Name Last, First, MI

6.) e-mail address 6.) phone number

6.) Classified VR Sent? YES NO 6.) Permission to provide contact info to other attendees?

YES NO

7.) Full Name Last, First, MI

7.) e-mail address 7.) phone number

7.) Classified VR Sent? YES NO 7.) Permission to provide contact info to other attendees?

YES NO

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Is your company interested in _j3ZIRdvMSqkITZL9idcUoA: Off
_3_) Permission to provide con_h9rLkjsFY-KKkUryKZDPpw: Off
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_2_) Permission to provide con_3WQIls2pqdlN9F7uQ4CnXw: Off
_2_) Classified VR Sent?_LZNZh9If0SJIXFoNgp46Kg: Off
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_2_) Full Name Last, First, MI_vhoRQnNFlI3Wr2SO4ASm5Q:
_1_) Permission to provide con_HIwbEKDyvZdUyJdkqZyQUg: Off
_1_) Classified VR Sent?_2c*WqgoWBefbdzB3*xtUYA: Off
_1 Phone Number_zLD1sArViOEjsYjeDE*6Rg:
_1_) e-mail address_BoSQS06vm-7j8gbUW7GL*w:
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COMPANY NAME_dH9MlzJfgu*24Kwh*KCBLQ:

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