U.S. Naval Academy
Annapolis, Maryland

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*
Phone Number* Cell Other
Re-enter Email*


Meal Information
Meals will be provided by the conference host. 
Please indicate any special needs for food. 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
Lactose Intolerant


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

The expectation is that participants will attend all three days of the conference.  


I will attend the conference on*

All three days
Sunday, November 4
Monday, November 5
Tuesday, November 6

The conference has the following 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 NASEC 2012 Web site for description of mentor role.)*  Yes No


Emergency Contact Information

Last Name*

First Name*


Day Phone* Ext 

Evening Phone*