REGISTRATION FORM for FLIGHT AND GROUND VEHICLE SIMULATION – JANUARY 2016
Please complete the following information to reserve a space in the next program. A confirmation letter will be emailed to you
within 2 weeks. If you don’t receive a confirmation letter, please email us at wtsnindy@binghamton.edu
SALUTATION (Mr./Ms./Dr. /LT/CPT):
FIRST NAME : as you would like it to appear on your certificate
FIRST NAME: as you would like it to appear on your Name Badge
Middle Initial:
LAST NAME:
(i.e. do you prefer to be called Bill or William? Dave or David)
TITLE:
DEPARTMENT:
ORGANIZATION/COMPANY:
ADDRESS:
CITY:
COUNTRY:
STATE/PROVINCE:
PHONE:
EMAIL:
MY FOCUS IS ON:
ZIP CODE:
☐ Flight Vehicle Simulation ☐ Ground Vehicle Simulation ☐ Other
# YEARS in SIMULATION INDUSTRY
SPECIAL ASSISTANCE or
DIETARY REQUEST:
I am registering for: (please check one)
REGISTRATION OPTIONS
FS16-01 Flight and Ground Vehicle Simulation
ONLY (5 day course) Jan. 18-Jan 22, 2016
FS16-01 Flight and Ground Vehicle Simulation
(5 day Course) Jan. 18-Jan 22, 2016 plus 2 day
Advanced Short Course (select your course
below) Jan. 25-26, 2016
2 day Advanced Short Course ONLY (select
your course below) Jan. 25-26, 2016
Early Bird
(before or on October 14, 2015)
UNIVERSITY/
INDUSTRY
GOVERNMENT
EMPLOYEE
☐ $1595
☐ $1695
Regular
(October 15, 2015 – January 8, 2016 )
UNIVERSITY/
INDUSTRY
GOVERNMENT
EMPLOYEE
☐ $1695
☐ $1795
☐ $2170
☐ $2270
☐ $2270
☐ $2370
☐
☐
☐
☐
$645
$695
$695
$745
Please select 2 day Advanced Short Course (Jan. 25-26, 2016)
☐
☐
☐
☐
FS16-02
FS16-03
FS16-04
FS16-05
Visual Systems Specification and Acceptance Test course (Instructor: Roy W. Latham)
Visual Database Design course (Instructor: Olen Atkins)
Systems Interoperability Standard course (Instructor: Dr. Siakou Y. Diallo)
Next Generation Display System Requirements, Metrics, and Measurements (Instructor: Dr.
Charles Lloyd)
☐ I am registering with a group. Please apply appropriate group discount.
I am paying by:
☐ CREDIT CARD (VISA, Mastercard, AMEX, Discover and PayPal. We will send you a PayPal link by email after
this form is received to obtain your credit card information.)
☐ CHECK (payable to Research Foundation Award 67070)
☐ WIRE TRANSFER (We will send you information after this form is received for wire transfers.)
☐ PURCHASE ORDER # __________________
You may return this form to Lisa Altman by email, fax or mail:
EMAIL: wtsnindy@binghamton.edu
FAX: 607-777-6256
MAIL: Lisa Altman, Office of Industrial Outreach
Watson School of Engineering and Applied Science
Binghamton University
PO Box 6000
Binghamton, NY 13902-6000
For Questions: Contact Lisa Altman at 607-777-2154 or email wtsnindy@binghamton.edu