5th International Symposium on 
Distributed Autonomous Robotic Systems


Oak Ridge National Laboratory Robotics Tour Registration Form

For tour on Friday, October 6, 2000

 



Name and Employer (for all registrants)
Last Name:
First Name:
Middle Name:
Current employer (name):
Your country of citizenship:
Your email address:

If you are a U.S. citizen, the above table is all the information you need to provide.

All other citizens, proceed with the following:

 

Other Personal Details (for all non-US citizens, including US permanent residents)
Date of Birth (MM-DD-YYYY): Male(M) or Female(F):
Education -- University (last attended): Highest degree earned (must be one of None, AS, BA, BS, MA, ME, MS, PhD, Other):

Year degree attained: Major:
City of birth: Country of birth:
Passport number (enter NA if U.S. permanent resident; enter AF if passport being applied for):

Passport expiration date:

Visa type (must be one of PRA (Permanent Resident Alien), B1-Business, H1-Employment, J1-Exchange Visitor, F1-Student, VWB-Visa Waiver Business,EAD-Employment Authorization Document, Other (please specify), none):

Visa expiration date:
If PRA visa type, include number, or if Other visa type, specify type:
Are you currently living in the U.S.? (Yes or No)
Current employment position:
Employer address (including street, city, state/province, country, postal code):


Organization represented/place of work (if different from current employer):
Address (including street, city, state/province, country, postal code):




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