FEMP Telereg Form

Use this form to register for a Satellite Teleconference and/or Webcast.
(If you experience server problems when submitting this form, please call 1-480-730-1388 for further assistance.)

Please provide the following contact information:
Note that upon successful form submission a confirmation reply may take up to 24 hours or longer due to server and Internet traffic issues.

Event Information (Multiple selections allowed, hold control key down during selections)

Events Date(s)
All Broadcasts will take place on the First Thursday of each month from 1:30 to 3:00 PM Eastern Time or 12:30-2:00 PM CT; 11:30-1:00 PM MT; or 10:30-12:00 Noon PT   Please convert to your time zone.

Need to Review Event Descriptions? Go To:
http://apps1.eere.energy.gov/femp/training/first_thursday_seminar_materials.cfm

Estimated First Time Viewer Audience *

Estimated Delayed View Audience *

Point Of
      Contact Name
*

Phone (Commercial)*

E-mail *

Technician's Name
(optional) (if different than POC).

Technician's Email

Unit/ Organization *

Address to send support material if any available from sponsor.
(Complete only if first time or new customer.)

City *

State *

Estimated Viewing Room Capacity

Open for Community Participation (thru coordination with you)?

Select Site Type

CDV/
Site ID If Military or Government digital GETN/Warrior satellite site, please fill in next two boxes.
Convergent
(example: AG-123B or AY-006A)
(ANG sites are requested to use their
"B" IRDs if available)

IRD(s) (Example: 2750320-6)

Additional Comments/Questions:

PLEASE, AGAIN NOTE that upon successful form submission a confirmation reply may take up to 24 hours or longer due to server and Internet traffic issues.

Privacy Statement

	Event Information (Multiple selections allowed, hold control key down during selections)
*Events Date(s)*	All Broadcasts will take place on the First Thursday of each month from 1:30 to 3:00 PM Eastern Time or 12:30-2:00 PM CT; 11:30-1:00 PM MT; or 10:30-12:00 Noon PT Please convert to your time zone. Need to Review Event Descriptions? Go To: http://apps1.eere.energy.gov/femp/training/first_thursday_seminar_materials.cfm
*Estimated*	**First Time Viewer Audience ***
*Estimated*	Delayed View **Audience ***
Point Of	Contact Name *
*Phone*	(Commercial)*
*E-mail*	*
Technician's Name (optional)	(if different than POC).
*Technician's Email*
*Unit/ Organization*	*
	Address to send support material if any available from sponsor. (Complete only if first time or new customer.)
*City*	*
*State*	*

Estimated	Viewing Room Capacity
Open	for Community Participation (thru coordination with you)?
*Select Site Type*
CDV/ Site ID	If Military or Government digital GETN/Warrior satellite site, please fill in next two boxes. Convergent (example: AG-123B or AY-006A) (ANG sites are requested to use their "B" IRDs if available)
*IRD(s)*	*(Example: 2750320-6)*
*Additional*	*Comments/Questions:* PLEASE, AGAIN NOTE that upon successful form submission a confirmation reply may take up to 24 hours or longer due to server and Internet traffic issues.

Last revised: February 03, 2012 Copyright 2002 Distributive Learning Networks All Rights Reserved

Last revised: February 03, 2012
Copyright 2002
Distributive Learning Networks
All Rights Reserved