US Disruption Mitigation Workshop

March 12-13, 2012, San Diego, California (General Atomics)
Registration Form

Please provide the following information:

First Name:                                    Last Name:
      

Affiliation:      

Street:            

City:               

State:         Zip:      Country:

Phone:             

Email Address:  

Participation Method: In Person    Remote

If you will attend in person, please respond to the following three questions:
      Are you a US citizen?: Yes    No

      IMPORTANT INFORMATION FOR NON-US PARTICIPANTS
      Per U.S. Department of Energy Foreign Visits and Assignments Order 142.3 chg. 1
      All non-U.S. citizens visiting the General Atomics Energy & Advanced Concepts Group
      must submit the information requested on the Non-U.S. Visitor Form.
      The form is located on the secured website:
      https://diii-d.gat.com/ssl_form/nonus/
      It is important to complete and submit the form no later than February 20.
      Approval must be obtained from the US Department of Energy prior to the visit.

      Do you already have a GA badge that will be valid March 12 and 13?: Yes    No
      If you plan to visit GA before or after the Workshop, who is your GA host?
      


NOTE: Due to the targeted nature of the workshop and the limited time available,
we may not be able to accommodate all requests for a presentation slot, or for a
particular length of time. You will be notified by February 27 of whether we are
able to include your talk in the agenda and for how long. The organizers intend to
reserve a large portion of the workshop time for discussions, so even if you are
not invited to give a presentation, you should have ample opportunity to contribute.

Do you wish to present during the workshop?: Yes    No
     if yes, title of presentation (optional, 80 character limit):
     
     short description or comments about presentation (optional, 300 character limit):
     
      requested time for presentation (minutes):  


Comments, questions or requests to organizers (600 character limit):