2024 Annual Program Review Registration

Please complete this form to register for the 2024 DOE NNSA SSGF & LRGF Annual Program Review and related activities. Once submitted, you will receive an automated e-mail confirmation. Please contact us if you have any questions.

Personal Information

First Name

Last Name

Badge Name

How would you like your FIRST name to appear on your badge?

Pronouns

Other

Which pronouns should we include on your badge?

Affiliation

E-Mail

Valid e-mail address (confirmation will be sent to this address).

Mobile Phone

Emergency Contact

Emergency Contact Name

Who should we call in case of an emergency?

Mobile Phone

Supplementary Information

What is your program affiliation?

Current Program Status:

Other Status

If you selected 'Other', please explain.

Planned Attendance

I will attend the following:

Hotel Reservation

Please complete this section ONLY if you require a hotel reservation.

The Krell Institute has reserved a block of rooms at the hotel for attendees at a special rate. To reserve a room within the Krell Institute block, check the box below and enter the requested information. Rooms will be guaranteed/direct billed to Krell's master account, however, guests will be asked to supply a credit card upon check in to cover incidentals.

I require a hotel reservation.

Check-in date:

Check-out date:

Which room type do you prefer?

Single (one bed)Double (two beds)

A special note for Federal employees: A limited number of government rate rooms have been reserved. Federal employees planning their own accommodations should contact us for more details.

Marriott Bonvoy members may opt to pay for their rooms and accumulate points for their stay. If a valid Marriott Bonvoy number is provided below, it will be submitted to the hotel and a credit card will be required at check-in. Lodging and incidental charges will be billed to the card and will earn Marriott Bonvoy points.

Marriott Bonvoy Number

Adaptive Room

Do you have any requests for your guest room (accessibility, allergies, etc.)?

Dietary Accommodations

Let us know how we can assist you. Please be as specific as possible.

Presentation Information

Please complete this section ONLY if you are a presenter.

I am presenting.

Krell recommends that you make use of the provided equipment since the presentations will be recorded, but if you have special requirements for your presentation and need to use your own, please indicate this below and provide more details in the comments section.

Which presentation software will you need?

Does your presentation have audio?

YesNo

Does your presentation have a movie? (Please provide the format and resolution of your movie in the comment box below.)

YesNo

The Krell Institute will make audio and video of your presentation available on the Internet following the event, but only with your express permission. Can your presentation be released?

I certify that my presentation has been released for posting online. It contains no information that needs to be withheld from publication for reasons of national security, export control, patentability or other intellectual property concerns (including copyright concerns). I either have the authority to release the presentation or assure the Krell Institute that it has gone through the necessary clearance process at my institution.I am unsure whether my presentation will be able to be released for public viewing (presentation will be withheld until receipt of a signed release).I am filling this form out as a representative of the registrant, and cannot affirm this statement (presentation will be withheld until receipt of a signed release).My presentation may not be released for public viewing.

Presentation Comments

Are there special items needed for your presentation?

Additional Comments

Your Message: