Please provide the following information:
First Name: Last Name:
Affiliation:
Address:
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 currently have a GA employee or GA long-term visitor badge?: Yes No Will you visit GA for more than March 12-13?: Yes No if yes, identify your GA host:
Do you wish to present during the workshop?: Yes No if yes, title of presentation (optional, 300 character limit): short description or comments about presentation (optional, 300 character limit): estimated length of presentation (optional):
Comments, questions or requests to organizers (600 character limit):
