Conference Registration -- Foreign

* Required Information.

The following information is required for foreign national visitors entering the NIST Gaithersburg facility. This requirement applies to all foreign nationals who do not have permanent resident status. Failure to provide this information prior to arrival on the site will result, as a minimum, in significant delays (up to 24 hours) in entering the facility.

Visitor Name

*First:
Middle:
*Last:

Birth Information

* Gender:	Male Female
* Date of Birth:	(mm/dd/yyyy)
*City:
*Country:

Passport Information

*Passport No.:
*Issuing Passport Country:

Citizenship Information

*Country of Citizenship:

Country of Dual Citizenship:	(if applicable)

National ID No:	(if applicable)

*Country of Residence:

Employment Information

Title/Position:
Employer/Sponsor:
Employer Street:
Employer Street:
Employer City:

Employer State:		Note: State is required for U.S. address only!

Employer Country:

Employer Zip/Postal Code:
Employer Phone:

Please fax completed form to Teresa Vicente at 301/948-2067