ICE Cancun 2016

Contact Information

Priority Code (If applicable)
* FirstName/Forename
Nick Name/First Name (will appear on badge)
* Last/Surname (will appear on badge)
Title
* Company/University (will appear on badge)
Day Telephone
Mobile Telephone
* E-mail
* Address Line 1
Address Line 2
* City (will appear on badge)
* Zip/ Postal Code
State (will appear on badge)
* Country of Residence (will appear on badge)
Country of Citizenship
Primary Emergency Contact Name?
Relationship
Home Telephone
Mobile Telephone
List any Medical Conditions/Allergies you may have
Member Number (If Applicable)

Demographic Information

Which best describes your occupation?
Academic Engineer
Geologist Geophysicist
Landman Other
Please Specify:
Which best describes your position?
CEO/President Independent Consultant
Manager Professor
Retired Staff Employee
Student Vice President
Other
Please Specify:
Age:
24 and under 25-29
30-39 40-49
50-59 60-69
70+
Gender:
Female
Male
Other
I wish to receive updates for ICE Events via mail/email
I need a letter for visa purposes
Special Needs?
Wheelchair Rental
Wheelchair Accessible
Vegetarian
Other Dietary Needs
Please Specify:
Would you like to be a judge?
Contact later
No
Yes
How many sessions are you willing to judge?
First choice for judging
Second choice for judging
Third choice for judging
Forth choice for judging
Fifth choice for judging
Sixth choice for judging
I am a: Check all that apply
Exhibitor
Poster Presenter
Session Course Instructor
Speaker
I am interested in finding out more about membership for AAPG and/or SEG, please send information.
AAPG
SEG
Not interested
I am interested in receiving more information about becoming an Exhibitor for future ICE events.
Yes
No
I am already an Exhibitor
I am interested in receiving more information about sponsorship for ICE Events.
Yes
No
I am already a sponsor
Please send Meet & Greet information
Yes
No

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