2024 PONI Summer Conference Registration
Personal Information
Salutation
First Name
Use your full legal name exactly as it appears on your government-issued ID
x
Middle Name
Use your full legal name exactly as it appears on your government-issued ID
x
Last Name
Use your full legal name exactly as it appears on your government-issued ID
x
Email
Phone
Job Title
Company/Affiliation
Gender
Male
Female
Accommodation Restrictions
Please let us know if you have any special needs (e.g. audio-visual, disability parking, dietary restrictions, etc.)
Mailing Information
Participant Mailing Address
Street Address
City
State
Two letter state abbreviation.
Zip Code
Country
Two letter country abbreviation.
Company Mailing Address
Street Address
City
State
Two letter state abbreviation.
Zip Code
Country
Two letter country abbreviation.
Please enter in the following format, as it appears on your government-issued ID:
US Citizenship
Please acknowledge if you are a U.S. citizen. If you are not a U.S. citizen by proceeding you understand that access to the PONI conference is dependent on approval by the host, which may require additional information and time to process. Admittance to the PONI conference is based solely on base access.
Are you a US citizen?
Yes
No
If not a US citizen, please list your citizenship
Date of Birth
Place of Birth (City, State, Country)
Social Security Number (SSN)
Driver's License Number (U.S. Citizens) OR Passport Number (Non-U.S. Citizen)
State of Issue (Driver's License) OR Country of Issue (Passport)
Medical Portable Electronic Devices (MedPEDs)
Do you have any sort of medical devices? (e.g. hearing aids, pacemaker, etc.)
Yes
No
What type of medical device(s) do you have?
Does your medical device have wireless and/or RF capabilities?
Yes
No
Badging
Clearance and Badging
I have a
DOE-issued
HSPD-12 standard security badge that I will bring with me.
I
do not
have a DOE-issued HSPD-12 badge. I will require a visitor badge.
I hold a DOE Q clearance.
I hold an active clearance from another government agency or non-government entity.
I
do not
have a clearance.
My clearance is held by (e.g. DoD, DOS, DHS, DoJ, NSA, CIA):
I acknowledge that the PONI Conference is an off-the-record event to foster more candid discussions. Please check to agree.
I Agree
2024 PONI Summer Conference Registration 2024 PONI Summer Conference Registration