Fall Stand Down 2010 Registration Form

Filling out the form as completely as possible helps us in assisting you in the best way possible. A vaild phone number is required so we can call you with pickup instructions.


General Info

Name
Gender

Date of Birth
Last 4 digits of SSN

Place of Residence

Type of Residence

Contact Info

Phone
Email

Military Info

Branch of the Military
Dates of Service
Start End
Discharge
Do you have a Military ID Card?

Other Info

Days Attending

Will you be staying the night?

Do you need transportation to and from the event?

Do you have an RTA/CTA pass?

Are you disabled or over 65 years of age?

How did you hear about the Stand Down?

For more information about NASA Education, contact Amy Johnson, Program Director, at 866-EDU-4YOU (866-338-4968) or send an email to Amy_Johnson@nasaeducation.org