Eastern OPSEC Forum Registration Form

15 - 17 September 2008

National Center for Language and Culture Research, College Park, MD

**A minimum U.S. SECRET Collateral security clearance is required to attend this event**

**NO INTERIM CLEARANCES PERMITTED**

Please select one of the following:

O Army O Navy O Marines O Air Force O Coast Guard

O Public Safety O Govt Civilian O Govt Contractor O Other _____________________

Legal First Name __________________ Last Name __________________________

Title/Rank (Optional) __________________

Organization _______________________________________________________

Address _______________________________________________________

City/State/Zip _______________________________________________________

Phone _________________________ Fax _________________________

Email _______________________________________________________

Your name as it should appear on Badge

First Name _________________________________

Last Name _________________________________

Rank (Optional) _________________________________

Organization _________________________________

• Cancellations

For information regarding cancellation or personnel substitutions, please call 443-479-4645 or email l.heaton@radium.ncsc.mil.

• Registration

Please copy and paste this form into a word document or email file and send your completed form to Linda Heaton, l.heaton@radium.ncsc.mil or print this form and fax to 443-479-4700. Upon receipt of your registration form, you will be sent an email Receipt. You will not be fully registered until your clearance information has been received and processed. You will be sent an email confirmation at that time.

NOTE : You are not registered for the OPSEC Forum until your clearance status has been verified.

• Fee