2019 DoDIIS Worldwide Conference 18-21 August 2019 – …

REGISTRATION TYPE

ATTENDEE INFORMATION

2019 DoDIIS Worldwide Conference 18-21 August 2019 ? Tampa, FL

DoD EMPLOYEE (ACTIVE MILITARY/CIVILIAN) and FEDERAL EMPLOYEE (NON-DoD) REGISTRATION FORM

Register online at

DoD Employees (Active Military/Civilian) and Federal Government Employees (Non-DoD) are eligible for free registration. Please select the appropriate box below to apply for a complimentary registration. Active Government/Military I.D required on-site.

DoD Employee (Active Military/Civilian)

Federal Government Employee (Non-DoD)

I hereby certify that the information above is correct and I am indeed a Government employee. I understand that misrepresenting myself as a Government employee will result in paying the full conference fee. Upon request I agree to submit proof of Government employment as verification. *All on-site contractor personnel must register at the Industry/On-Site Contractor rate online or by form.

Prefix

First Name

First Name or Nickname to appear on badge

Co/Organization to appear on badge

Military Branch (if applicable)

Preferred Mailing Address

City

Daytime Phone

MI

Last Name

Job Title/Position

Employer

Grade/Rank/Position (i.e. GS 11, SES, E 8, 0 7)

Cell Phone

State

Postal Code

Citizenship (US, UK, AUS, CAN, NZ citizenship is required to attend)

Unclassified E-mail Address (for confirmation and receipt)

ADA/Special Requirements

For planning purposes, please indicate which of the following functions that you plan to attend while at the conference: Registration Mixer - Sun, 18 August Opening Plenary Sessions - Mon, 19 August All Hands Networking Social - Mon, 19 August Plenary Sessions ? Tuesday, 20 August Plenary Sessions ? Wednesday, 21 August

Lunch and Learn ? Enjoy a complimentary box lunch and presentation. Please select only ONE per day. Note: All Titles and Descriptions can be found on the 2019 DoDIIS Conference Website under "Lunch and Learn"

Monday, August 19 ? Presented by IBM Monday, August 19 ? Presented by Confluent Tuesday, August 20 ? Presented by ForcePoint Tuesday, August 20 ? Presented by Red Hat Wednesday, August 21 ? Presented by Allied Telesis Wednesday, August 21 ? Presented by Microsoft

Opt In/Out to Share Contact Information with all DoDIIS Conference Participants

Yes, please share my information No, please do not share my information

Cancellation: All cancellations must be received in writing no later than 23 July 2019. *SUBMISSION OF REGISTRATION FORM ACKNOWLEDGES THESE POLICIES**

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Note to DoD and Military Members Wishing to Attend DoDIIS: Per DoD Conference Guidance, conference attendance for Government and Military personnel is subject to approval and registration on this form does not guarantee confirmation to attend. Registration can be cancelled or denied based on factors such as budgetary

constrictions, mission relevancy, and distribution of representation amongst services and agencies.

REQUIRED

CANCELLATION

Please email or fax completed forms to: nixon@ or 443-561-2405. For more information or questions, call Ann Marie Nixon at 443-561-2404.

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