Workshop and Banquet Registration

Please complete the following information to register for the 2008 HPEC Workshop.

* Prefix:
* First Name:	Middle:
Preferred Nickname:  (Optional)
* Last Name:
* Organization:
* Address1:
Address2:
* City:	* State:     * Zip:
* Phone:
Fax:
* E-mail:
* Please specify the event(s) you are requesting to attend:
	Workshop only
	Workshop and banquet
	Workshop only as student
	Workshop and banquet as student
* Please check appropriate citizenship status:
	United States Citizen
	U.S. Permanent Resident (Green Card Holder) Note: You will be required to show your Green Card to the Security Office EACH day you attend the workshop.
	* Primary Country of Citizenship:
	Foreign National * Country of Citizenship:
	Visa Holder * Country of Citizenship:
	* Please indicate visa type:
	Student
	Work
	Note: Foreign Nationals and Visa Holders are required to fill out MIT Lincoln Laboratory’s Foreign National Visit Request Form, requesting approval to attend this workshop. This form will be included in the Invitation Package.
* Please check appropriate affiliation:
	Government
	Industry
	Academia
	Military
* Please indicate whether you have special requirements, e.g., handicap access needs, dietary restrictions, etc.
	Yes. I will email my requirements to the HPEC Workshop Office, div10-wkshopoffice@ll.mit.edu.
	No
Please indicate if you DO NOT want your name to appear on the Attendee/Registration list.
* Required fields