URTeC 2018

Contact Information

* Priority Code
* First Name/Forename (will appear on badge)
* Last Name (will appear on badge)
Title
* Company (will appear on badge)
Telephone
Fax
* Email
Street1
Street2
City (will appear on badge)
ZipCode
State (will appear on badge)
* Country (will appear on badge)
* Name of Host Organization
Country of Residence
Country of Citizenship

*I certify that the above information is true and correct.

Demographic Information

*Member of the following? (Check all that apply)
Society of Petroleum Engineers (SPE) American Association of Petroleum Geologists (AAPG)
Society of Exploration Geophysicists (SEG) American Institute of Chemical Engineers (AIChE)
Association for Iron & Steel Technology (AIST) American Society of Civil Engineers (ASCE)
The American Society of Mechanical Engineers (ASME) Society for Mining, Metallurgy & Exploration (SME)
Society of Petroleum Evaluation Engineers (SPEE) Society of Petrophysicists and Well Log Analysts (SPWLA)
The Minerals, Metals and Materials Society (TMS) American Rock Mechanics Association (ARMA)
None of the above
I am a(n): (Check all that apply)
Exhibitor Field Trip Leader
Panel Member Panel Moderator
Session Chair Short Course Instructor
Speaker (Technical Presenter) Sponsor
Technical Program Committee Member
*Which best describes your profession?
Academic Economist/Financier
Engineer Geologist
Geophysicist Landman
Service Company Personnel (field technician, production supervisor, mechanic, etc) Other
*Which best describes your position?
CEO/President
Vice President
Director
Manager
Professor
Consultant
Staff Geologist
Staff Engineer
Staff Geophysicist
Marketing/Sales
Student
Retired
Self Employed
Displaced
*Age:
24 and under 25-29
30-39 40-49
50-59 60-69
70+
*Gender:
Female
Male
What (if any) are your special needs?
Wheelchair Rental
Wheelchair Accessible
Vegetarian/Vegan
Gluten Free
Other Dietary

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