JIFX14-2 Event Registration



Personal Information


* First Name

* Last Name

* Citizenship
Choose one of the following answers
* E-mail Address

* Work Number

Cell Number

* May we share your contact information with other event participants?
Organization


* Organization

* Rank or Title

* Business Address

* City

State
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Zip Code
Only numbers may be entered in this field.

* Country
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Attendance Information


* Which days will you be attending? 
Check any that apply
Comments/Requests

Non-US Citizenship: Additional Information Required


* Date

* Full Name (as it appears on your passport)

* Date of Birth

* Place of Birth

* Passport Number

* Passport: Country of Origin

* Country of Residence

* Position/Rank

* Employed by

* Nature of Visit
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* Purpose of Visit

* Description of material to be discussed

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