Virtual Worlds Conference

2nd Annual T2 Virtual Worlds Conference

July 28, 2011 Seattle Science Foundation

2011 T2 Virtual Worlds Conference Registration

Conference: 2011 T2 Virtual World Conference

Date/Time: July 28, 2011; 7:30AM - 4:15PM SLT (Pacific)

Location: Seattle Science Foundation/Online

Note 1: If you are attending in person for this conference, you DO NOT need to fill-in this registration form.

Note 2: You will receive a confirmation e-mail to save/print after you fill in the required areas and click the "Submit Your Registration" button.

* = Required

First Name: *

Last Name: *

Preferred Contact E-Mail Address: *

Preferred Contact Phone #:

Please include your area code, example: 555-123-4567

Mailing Address - Line 1:

Mailing Address - Line 2:

Use this area for any building or suite number.

City:

State:

Please use the two-lettered code for your state.

Zip Code:

Highest Degree:

Please enter your hightest medical/college degree you have achieved.

License/Certification(s):

Please enter all your license/certification(s).

Position/Title: *

Organization/Institution Name: *

Department: *

Organization Type:

Government

Contractor

Vendor

Private Sector

Registered Second Life Avatar: *

If you are participating via Second Life, what is your registered SL avatar name?