The In-Person Event Gov't Participant Registration -

Which event are you participating in? *

Basic Information

Name *

First

Last

Rank/Title

Organization *

Work Email *

Personal Email

Phone *

Do you agree to share your basic contact information with other participants in this project? *

Base Access

Do you have a valid CAC? *

Yes
No

If Yes, please provide your CAC Expiration below. In No, please provide your driver license information below for base access.

CAC Expiration Date *

Please enter your CAC expiration date.

Date of Birth *

Driver's License # *

State of Issuance *

Other Information

Will you register for or opt out of meals? *

Please visit the provided EventBrite link to register and pay for meals if you choose to opt in. You may find the meal ticket by searching the event name on EventBrite if a link has not been sent to you directly.

Please list any dietary restrictions so that we may make accommodations. *

Please list any snack or beverage requests here. *

We will do our best to accommodate preferences.

1. Submit your collateral (Non-SCI) clearance if applicable to the following JPAS SMO Code: US0BF4FW6

POC information:

SMO code: NJ1CFTS6

Reason: Hack-a-Thon

ShOC-N POC: Mr. Jimmy “Rev” Jones

Dates: January 5th-12th

ShOC-N Security Manager: Mr. James Cooper

Email: james.cooper.48@us.af.mil

Comm/STE: 202-767-3977 (Currently INOP)

Cell: 661-348-0822

NSTS: 987-4157

Comments or questions on your participation: