AFCEA Member Status?	Member of AFCEA NonMember
Membership Number
Prefix/Rank
First Name
Last Name
Title/Position
Company/Service/Org
Company Size	1-99 employees 100-499 employees 500 or more
Email
Tel
Fax
Address Street
Address City
Address State
Address Zip
Special Needs
Registration Rate	_____________________________________________ Industry Individual - $35 Industry Individual Non-member - $40 Industry Corporate Table Holder - No Charge     (Please select "Industry Table Holder - No Charge"      under Payment Method Below!) Government - No Charge     (Please select "Government - No Charge"      under Payment Method Below!)
Please tell us about you and your company.	_____________________________________________ Organization Please Select One Below Active Air Force Active Army Active Coast Guard Active Marine Corps Active Navy Business/Industry Consultant Defense Civilian Employee Educator/Academia Full-time Student Non-Defense Civilian Employee State/Local Government Other (describe)       Other Your Occupation or Area of Expertise Data Processing Engineering/R&D Information Systems/IRM Maintenance Management Operations Procurement/Test & Eval Production Sales/Marketing Other (Describe)       Other Your Company/Org's Area of Specialty Avionics C3I C4I Command/Control Communications Computers Computers in Communications Electronic Warfare Electronics Emergency Management Information Management Intelligence Law Enforcement Public Safety Radar Satellites Systems Management Other (Describe)       Other
Would You Like to be Contacted About Becoming A Corporate Table Holder?	_____________________________________________ Yes, Please contact me about sponsorship opportunities. No thanks, not at this time. _____________________________________________
COMMENTS How did you hear about the AFCEA NOVA Monthly Luncheon?
PAYMENT
Payment Method	Please Select One (And Did you Push to Total Above?) Credit Card - Be Sure You Pushed the Total Button Above Check - Be Sure You Pushed the Total Button Above Government Employee - No Charge Volunteer - No Charge Industry Table Holder - No Charge Press - No Charge Speaker or His/Her Staff Aid - No Charge Guest - No Charge with prior approval
All Check Payments Should Be Mailed To: AFCEA NOVA Events c/o Capital Leadership Group 428 Hume Ave., 2nd floor Alexandria, VA 22301 tel: 703-997-3006 Deadline for cancellations or refunds: 48 hours prior to the event. No refunds thereafter. Form created by: Capital Leadership Group Where the Public, Private, and Civic Sectors Converge. Copyright © 2006 [Capital Leadership Group] All rights reserved.