Registration Form First Name * Last Name * Email Address * Address Line 1 * Address Line 2 Address Line 3 City * State * Zip Code * I am a/an * undergraduate studentgraduate studentstaff memberfaculty memberdepartment chairpersoncommunity member – not affiliated with a college or universityOther If you are an undergraduate student, what is your standing? If this section does not apply to you, choose N/A. FreshmanSophomoreJuniorSeniorN/A Media/Film/Photography Opt Out: I do not authorize the NCSA to use my image, photograph, video, or the like for any NCSA-related purpose, including but not limited to promotion, publicity, and/or advertisement. If you choose to opt-out, then it is your responsibility to excuse yourself from any media activity at the conference. Opt Out
