This form should be completed by the student's instructor
Instructors must attend an orientation at the Satellites & Education Conference
prior to registering any students

Complete the this registration form carefully and completely.
Please submit your registration only once.
If some resulting information is incomplete you will be contacted.
Lines marked (*) will be on your badge.
Fields shaded in yellow are required fields
The badge issued to each registrant is the ticket for admission to all sessions, exhibits and events.

Each M.Y. S.P.A.C.E. student and teacher should be registered separately by the teacher.

Badge Data:

Are you:

First Name* Last Name*

Position / Title* Organization*

Mailing Address (we recommend you use your home address)

Street Address

Address (cont.) Country:

City State/Province Zip/Postal Code

Phone

E-mail

Do you need SPECIAL ASSISTANCE due to a disability?

Special Assistance Needed	What kind of special assistance do you require? Please be specific.

If this is a student enter teacher's name: And teacher's email address:

Registration Fees	Additional Items	Enter Number Required (include Partner/Spouse)
	# Attending Friday Night Banquet:	No Fee
	Steak Dinner Vegetarian Dinner
Double check your information before clicking "Submit". If you have to come back to make a correction after submitting, this form will then be sent twice.

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Are you:
First Name*		Last Name*
Position / Title*	Organization*
Mailing Address (we recommend you use your home address)
Street Address
Address (cont.)	Country:
City	State/Province Zip/Postal Code
Phone
E-mail

This form should be completed by the student's instructor Instructors must attend an orientation at the Satellites & Education Conference prior to registering any students

This form should be completed by the student's instructor
Instructors must attend an orientation at the Satellites & Education Conference
prior to registering any students