Spring 2016 Speaker Registration Form

April 17–20, 2016
The Fairmont Washington, D.C., Georgetown

Please complete this form and submit by March 2, 2016

For questions, please email [email protected]

    Full Name *
    *required
    Nickname for badge *
    Title *
    Firm or Affiliation Name *
    Street Address *
    City *
    State *
    Zip or Postal Code *
    Country *
    Business Telephone *
    Cell Phone *
    Email *
    Will Your Spouse/Guest be Attending?
    Name for Badge Spouse/Guest
    Home City & State for Spouse/Guest
    Please indicate your ARRIVAL and DEPARTURE dates *
    Will you be staying at the Fairmont Washington D.C. Georgetown?
    YesNo
    If NO, what is the name of the hotel where you will be staying?
    When will your PAPER be submitted for website posting? *
    When will your SLIDES be available for printing and website posting? Deadline is March 17. *
    Will you be attending the following reception/dinners?
    Sunday evening
    YesNo
    Monday evening
    YesNo
    Tuesday evening
    YesNo

     

    captcha
    Thank You!