Space Exploration Alliance 2012 Blitz
February 26-February 28, 2012 in Washington, DC
Online Conference Registration
If you are an NSS member and the fields below are empty, click
Fields marked with a red asterisk
*
are required.
Enter "n/a" for fields that do not apply.
Section I – Contact Information
*
First Name(s):
*
Last Name:
(Please select your Country first. If not found, select your Continent to bring up list.)
*
Country:
United States
Australia
Brazil
Canada
China
France
Germany
India
Ireland
Italy
Mexico
Japan
Russian Federation
United Kingdom
-------------
North America
Caribbean
Central America
South America
Europe
Middle East
Africa
Asia
Australia
Pacific
Antarctica
*
Street Address:
*
Town/City:
*
Postal Code:
*
State/Province:
(other) -->
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands (U.S.)
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other:
Please provide an email address to receive confirmation of this transaction.
*
E-Mail Address:
*
Phone Number:
Country Code +
Fax Number:
Membership # (if known):
Member of Congress:
Date of Birth:
Have you participated in a congressional briefing event before?
Yes
No
If so, please describe briefly below (include organization represented)
Section II – Registration Information
WILL ATTEND:
(check days that you
intend to participate)
Sunday (February 26) training (2pm-5pm -
required
)
Monday (February 27)
Tuesday (February 28)
Registration Options
:
Adult
$25
Student (requires valid student ID)
$0
Registration Fee:
$
By Registering, I certify that I will be at least 18 years of age on or before February 26, 2012. (Minors are encouraged to attend but must be accompanied at all times by a parent or an adult with legal responsibility for the conduct and safety of the minor. Both Minor and guardian must register to attend).
All Applications are subject to approval and acceptance by the National Space Society.
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