NRC Registration Form *

NRC 2019 Registration

* Name

* Cell/Phone

* Email address for NRC

* KSEA Membership Status?

KSEA Member

KITEE Member

Non-Member & Working Professional

Non-Member & Student

Please, Type your KSEA Membership No# ( Non member skip this )

* Current your Company/University

* Your affiliations ?( As many as yours) *

KSEA NY Metro Chapter

KSEA NJ Chapter

KSEA Philadelphia Chapter

NYKB

PKSA

KASBP

KITEE

Others (University/College/etc)

If you checked "Others (University/College/etc)", please specify your affiliation.

* Your Career Field?

Computer/Data Science

Physical Science

Health/Medical

Engineering

Life Science

**Others

**If you checked "Others", please specify your Career Field.

***The shuttle bus will be provided at 7:50am (ONLY once) from Columbia University (Morningside Campus)
to Montclair State University for NRC 2019.
(Any other travel support will NOT be provided from NY Metro Chapter. )
Returning service will also be provided after a networking dinner at NRC 2019.

* Are you going to take this shuttle bus?

Yes. I will take the shuttle bus.

No.

***We are going to have a complimentary networking dinner
at the conference center right after NRC 2019.
(Not moving anywhere)

* So are you going to join the networking dinner?

Yes.

No.

* If so, are you going to drink complimentary Beer/Wine? (Soft drinks will be provided with dinner.)

Yes.

No.

If Yes, your DOB should be checked and a wristband will be provided for your Beer/Wine on your registration.

* Favorite pastime activity? (Choose one for networking dinner!)

Reading

Exercising

Cooking/Baking

Drawing

Home Projects

No Dinner

* Field Label