ARMED FORCES COMMUNICATIONS & ELECTRONICS ASSOCIATION

1. Marriott Newton Hotel Newton, MA ARMED FORCES COMMUNICATIONS & ELECTRONICS ASSOCIATION New Horizons Symposium 26/27 January 2010 REGISTRATION FORM Name: Position: Address: State: Zip Code: Fax: Name: Company/Organization: Address: City: Telephone: E-mail: MAKE CHECKS PAYABLE TO: AFCEA. REGISTRATION MUST BE COMPLETED BY JANUARY 15, 2010. NO CANCELLATIONS ACCEPTED AFTER JANUARY 15, 2010. TELEPHONE REGISTRATION WILL NOT BE ACCEPTED. • I understand that the contents of the briefings are for informational purposes only and may represent the views or opinions of the individual briefers. • A portion of the proceeds from the Symposium may be allocated to the Lexington-Concord Chapter’s Educational Fund, a not-for-profit, tax exempt public charitable fund. A sign up sheet will be available at the Symposium Registration desk where you can provide an email address should you want to know the amount of the registration fee that may be allocated for charitable purposes. • An attendee list will be published and distributed to all registrants. The attendee list will include name, title, address, and telephone number. If you do not want your information to be published, please check here. $495 ~ AFCEA Member __________ $540 ~ Non-member $165 ~ Active Duty Military/Government Civilian Note: Fee includes State of ESC Luncheon Registration received after 15 January 2010 will be charged a $50 late fee. Signature Date Four Easy Ways To Register Payment Amount $ _______________ Check (made payable to AFCEA) Credit Card: Online: www.afceaboston.com Mail to: AFCEA, Lexington-Concord Chapter c/o Oasis Systems, Inc. Attention: Claire Goulet 81 Hartwell Avenue Lexington, MA 02421 Fax: with credit card info to 781-676-7353 E-Mail: cgoulet@oasissystems.com MasterCard Visa Amex Card Number Exp. Date Name on Card Signature For more information and registration questions, visit our website: www.afceaboston.com or Contact Claire Goulet 781-676-7344; cgoulet@oasissystems.com