U.S. Naval Academy
Annapolis, Maryland

Non-USNA Faculty Registration Form
Naval Academy Science and Engineering Conference (NASEC)
Sunday, 4 November through Tuesday, 6 November 2012
 

Please complete and click on the SUBMIT button at the end of this form.

Registration closes at 1600 on Friday, 26 October 2012.
*Asterisks indicate required fields.

Disclaimer: Information is for conference use only and will not be released.

 
Personal Information
 
Last Name*
First Name*
Preferred Name on Badge*
College/University*
College/University Office Address*
 		 Street
City State Postal  Code
Phone Number* Cell Other
Email*
Re-enter Email*

 

Lodging and Meal Information
 
Lodging and meals will be provided by the conference host. (See NASEC 2012 Web site for specifics.)  Faculty will be housed in single-person rooms in a local hotel within walking distance of the Naval Academy. A continental breakfast will be provided at the hotel on Monday and Tuesday mornings.
 
I will need lodging for the nights of:* Sunday, November 4
Monday, November 5
I will NOT need lodging
   
Please indicate any special needs for food or housing purposes. Special food needs MUST be pre-arranged with the caterer. Only those who indicate their needs on this form will be accommodated at meals and breaks.   Gluten Intolerant
Vegetarian
Lactose Intolerant
Need ADA Compliant Housing

 

Conference Information (Sunday, 4 November  -  Tuesday, 6 November)
 

The expectation is that participants will attend all three days of the conference.  Requests for attendance on fewer days will be accommodated as space allows.
 

I will attend the conference on*
All three days
Sunday, November 4
Monday, November 5
Tuesday, November 6
 

The conference has three concurrent sessions:

  • Energy and Alternative Fuels

  • Cyber Space and Security

  • Water and Sustainability

Please consult the NASEC 2012 Web site for brief descriptions of the sessions, and then indicate your preference for session attendance throughout NASEC 2012.
 
  1st Choice 2nd Choice 3rd Choice

Energy and Alternative Fuels*

Cyber Space and Security*
Water and Sustainability*
     
Are you interested in serving as a mentor at any of the sessions? (See Website for description of mentor role.)*  Yes No

 

Emergency Contact Information
 
Last Name*

First Name*

Relationship

Day Phone* Ext 

Evening Phone*

Email