DARS 2000 ORNL Tour Registration Form

5th International Symposium on
Distributed Autonomous Robotic Systems

Oak Ridge National Laboratory Robotics Tour Registration Form

For tour on Friday, October 6, 2000

Due to security restrictions at Oak Ridge National Laboratory, it is mandatory that all visitors register in advance for the tour. Those not registering by the deadline cannot attend the tour.
Please complete all sections of this form. Print the form and mail or fax to the DARS Conference Secretary at:
DARS 2000 Conference Secretary
Oak Ridge National Laboratory
Center for Engineering Science Advanced Research
P.O. Box 2008
Oak Ridge, TN 37831-6355
USA

Fax: +1-865-574-0405
Deadlines:
- Non-U.S. Citizens (includes U.S. permanent residents): September 1, 2000
- U.S. Citizens: October 4, 2000
Please be sure to complete all information. Incomplete forms cannot be processed for admission to the ORNL tour. One person per form only, please.

Name and Employer (for all registrants)

Last Name:
First Name:
Middle Name:

Current employer (name):

Your country of citizenship:

Your email address:

**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):

**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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