MEDUSA Industry Day Registration Form.pdf

To attend the MEDUSA Industry Day, complete this form and provide by email to Cristina Vega, Contracts Specialist, at cristina.a.vega5.civ@us.navy.mil and CC Eric Dieges, Contracting Officer, at eric.dieges.civ@us.navy.mil. All interested companies must reference “Your Company Name - MEDUSA Industry Day Registration” in the subject line. Forms are due by 11 May 2022 at 1700 EST.

Please indicate via checkmark in the box below if your company requests a MEDUSA Engagement session, and mark the preferred medium (Virtual or In-person):

☐ Request Virtual Engagement session ☐ Request In-person Engagement session

Please indicate via checkmark below if your company intends to discuss classified information during the engagement session (applicable to in-person sessions only):

☐ Intend to discuss classified information

Please provide below the attendees you request the Government to send an invite to for participation in the live-event (note: each company is limited to “2” points of contact during the Part 1 Government presentation).

Company Name

CAGE Code / DUNS Number

Unclassified Mailing Address

Attendee No. 1

Name:

Company:

Title:

Phone:

Email:

Attendee No. 2

Name:

Company:

Title:

Phone:

Email:

Attachment:

MEDUSA Industry Day Registration Form