[2493] in peace2
Re: REGISTER BY TODAY: Email version of registration
daemon@ATHENA.MIT.EDU (Jan Outcalt)
Wed Apr 23 13:59:42 2003
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In-Reply-To: <200304231749.NAA07349@horsepower.ai.mit.edu>
Date: Wed, 23 Apr 2003 13:58:29 -0400
To: Devon Sean McCullough <Devon@ai.mit.edu>
From: Jan Outcalt <jano@MIT.EDU>
Cc: peace-discuss@mit.edu, peace-announce@mit.edu, no-war@mit.edu
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Fill in the blanks and then forward the email to: tppsymp@mit.edu.
I think this should work.
==========================================
Registration Form
Global and Homeland Security:
Science, Technology, and the Role of the University
Friday, May 2nd, 2003
Sponsored by: the Sloan Foundation, the MIT Engineering Systems
Division, the MIT Center for International Studies, the MIT Program
in Science, Technology and Society, the MIT President's Office,
and the MIT Technology and Policy Program
Registration is required for this event.
We cannot guarantee space for late or same-day registrations.
PLEASE ENTER ALL INFORMATION PLEASE TYPE OR PRINT
(Please circle) Dr. Prof. Mr. Ms.
Industrial Liaison Program member? Yes No
First Name ______ Last Name _________________________
Name to appear on name badge (if different)
_____________________________________________________________
Title ______ _____________________________________________________________
Academia__ Student____ Government____ Consultant____ Private
Sector____ Think tank____ NGO____ Other____
Affiliation: Organization/Company Name:___.,
MIT______________________________________
Department/Program___
______________________________________________________________
Mailing Address Line 1
_______________________________________________________________________
Mailing Address Line 2
_____________________________________________________________
City ____Cambridge____________________________ State ____MA_______
Zip ___02139 ______
Telephone Number: ____________________________________ Ext
_________________
Email
_______________________________________________________________________________
Please check one: _______ I will attend the luncheon and keynote address
Special requests:
Vegetarian ________ Other
(specify)___________________________________
_________ I will not attend lunch
Please submit completed form as soon as possible, and
no later than Wednesday, April 23rd to guarantee your seat at the symposium:
Homeland Security Symposium; Attn: Ms. Fran Marrone
77 Massachusetts Avenue, Room E40-249
Cambridge, MA 02139
Fax (617) 258-7733 Phone (617) 253-4885 Email: tppsymp@mit.edu
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blockquote, dl, ul, ol, li { margin-top: 0 ; margin-bottom: 0 }
--></style><title>Re: REGISTER BY TODAY: Email version of
registration</title></head><body>
<div><font face="Helvetica" color="#000000">Fill in the blanks and
then forward the email to: tppsymp@mit.edu. I think
this should work.</font></div>
<div><font face="Helvetica"
color="#000000">==========================================</font></div
>
<div><font face="Helvetica" color="#000000"><br></font></div>
<div><font face="Helvetica" color="#000000"><br></font></div>
<div><font face="Helvetica" color="#000000"><b>Registration Form<br>
<br>
Global and Homeland Security:<br>
Science, Technology, and the Role of the University<br>
Friday, May 2nd, 2003<br>
<br>
</b>Sponsored by: the Sloan Foundation, the MIT Engineering
Systems Division, the MIT Center for International Studies, the MIT
Program in Science, Technology and Society, the MIT President's
Office,<br>
and the MIT Technology and Policy Program<br>
<br>
<br>
<i><b>Registration is required for this event.<br>
We cannot guarantee space for late or same-day registrations.<br>
<br>
<br>
</b>PLEASE ENTER ALL INFORMATION</i></font><font face="Times"
color="#000000"><x-tab> </x-tab></font><font
face="Helvetica" color="#000000"><i>PLEASE TYPE OR
PRINT</i><x-tab> </x-tab><br>
<br>
(Please circle) Dr. Prof. Mr.
Ms.<x-tab>
</x-tab> <x-tab>
</x-tab><x-tab>
</x-tab><x-tab> </x-tab>
Industrial Liaison Program member? Yes
No</font></div>
<div><font face="Helvetica" color="#000000">First Name ______
Last Name _________________________</font></div>
<div><font face="Helvetica" color="#000000">Name to appear on name
badge (if different)
_____________________________________________________________</font></div
>
<div><font face="Helvetica" color="#000000">Title
______<u><x-tab>
</x-tab>_</u
>____________________________________________________________</font></div
>
<div><font face="Helvetica"
color="#000000">Academia__<u><x-tab>
</x-tab></u> Student____ Government____ Consultant____ Private
Sector____ Think tank____ NGO____ Other____</font></div>
<div><font face="Helvetica" color="#000000">Affiliation:
Organization/Company Name:___<u>.</u>,<u>
MIT</u>______________________________________</font></div>
<div><font face="Helvetica"
color="#000000"
> <span
></span>
Department/Program___<u><x-tab>
</x-tab></u
>______________________________________________________________</font></div
>
<div><font face="Helvetica" color="#000000">Mailing Address Line 1
_____________________________________________________________________<span
></span>__</font></div>
<div><font face="Helvetica" color="#000000">Mailing Address Line 2
_____________________________________________________________</font></div
>
<div><font face="Helvetica" color="#000000">City
____<u>Cambridge</u>____________________________ State
____<u>MA</u>_______ Zip ___<u>02139<x-tab>
</x-tab><x-tab>
</x-tab></u>______</font></div>
<div><font face="Helvetica" color="#000000">Telephone
Number:<u><x-tab>
</x-tab>__</u>__________________________________ Ext
_________________</font></div>
<div><font face="Helvetica" color="#000000">Email
_____________________________________________________________________<span
></span>__________</font></div>
<div><font face="Helvetica" color="#000000"><b>Please check
one:</b><x-tab>
</x-tab>_______<x-tab> </x-tab>I will attend the luncheon and keynote
address</font></div>
<div><font face="Times"
color="#000000"><x-tab>
</x-tab><x-tab>
</x-tab>S</font><font face="Helvetica" color="#000000">pecial
requests:<br>
</font><font face="Times"
color="#000000"><x-tab>
</x-tab><x-tab>
</x-tab></font><font face="Helvetica" color="#000000">Vegetarian
________ Other
(specify)___________________________________<br>
<x-tab>
</x-tab>____<u>___</u>__<x-tab>
</x-tab>I will not attend lunch<br>
<i><b>Please submit completed form as soon as possible, and<br>
no later than Wednesday, April 23rd to guarantee your seat at
the symposium:<br>
</b></i>Homeland Security Symposium; Attn: Ms. Fran Marrone<br>
77 Massachusetts Avenue, Room E40-249<br>
Cambridge, MA 02139<br>
Fax (617) 258-7733 Phone (617) 253-4885
Email: tppsymp@mit.edu</font></div>
</body>
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