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GUIRR June 2016 Meeting

Building Smart Communities for the Future
June 21-22, 2016

Keck Center of the National Academies of Sciences, Engineering, and Medicine
500 5th St, NW
Washington, DC 20001

1. Please fill out the form below to register for this event.

Prefix *This question is required.

First Name *This question is required.

Last Name *This question is required.

Badge Name *This question is required. (First Name or Nickname Only)

2. Business and Contact Information

Title *This question is required.

Affiliation *This question is required.

Address Line 1 *This question is required.

Address Line 2

City *This question is required.

State *This question is required.

Zipcode *This question is required.

Email *This question is required.

Phone *This question is required.

Fax

3. Will you be attending the Keynote Dinner on June 21, 2016?

Would you prefer a vegetarian meal?

4. Will you be attending the General Meeting on June 22, 2016?

5. Will you be joining us for lunch during the General Meeting?

Would you prefer a vegetarian meal?

6. Please list any food allergies and supply us with an emergency contact (name and number only):

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