Industry_Day_Registration_Form_17-R-0066.doc

REGISTRATION FORM

INDUSTRY DAY

SOLICITATION W52P1J-17-R-0066

07 June 2017 Arsenal Island Golf Course & Clubhouse 1838 Gillespie Street

Rock Island, IL 61201 US Company Name: _______________________________________

Company Address & Phone_____________________________________

Name of Representative: _______________________

Phone: _______________ Email: _____________________

Is the Visitor a U.S. Citizen? Yes / No

Name of Representative: _______________________

Phone: _______________ Email: _____________________

Is the Visitor a U.S. Citizen? Yes / No Name of Representative: _______________________

Phone: _______________ Email: _____________________

Is the Visitor a U.S. Citizen? Yes / No

Name of Representative: _______________________

Phone: _______________ Email: _____________________

Is the Visitor a U.S. Citizen? Yes / No Request One-on-one Session? Yes/No

ALL ATTENDEES MUST BE REGISTERED. Registration for the conference is scheduled to start at 7:45am and presentations will begin at 8:30am. You must pre-register for this Industry Day to ensure your admittance. All attendees must email their completed registration form no later than 12 May 2017 to Bridget.L.Kramer.civ@mail.mil. Any specific questions about the Industry Day should also be emailed to Bridget Kramer. Please see the release form below for placing company contact information on our website.

RELEASE OF NAMES OF INDUSTRY DAY ATTENDEES - We typically share the company names, attendee’s names, telephone, and email address with other attendees from the Industry Day to facilitate subcontracting and teaming arrangements. Before releasing the name of your company, your name, telephone and email address to the web, we need your authorization to do so. If you do not want such information to appear, please provide a corporate or general office email and telephone number that may be listed instead. Whatever information you agree to release to the web will be the information we provide to attendees. Please state whether we can release information about your attendance at the Industry Day on 07 June 2017.

RELEASE INFORMATION? YES _______ NO _______

If YES, specify what information we can release:

Company name: _______

Your/Office Name: _______

Telephone: _______

Email: _______