2014 DPI Registration Information

In order to register for the DPI conference you must fill in the following information completely and accurately. If you have any questions or concerns, please contact Chanteclaire Lantos-Swett at clantos-swett@unausa.org.

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* Please enter the following information:

Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Country: *

Email Address: *

Phone Number: *

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* Weight (Indicate whether kg/lbs)

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* Height (Indicate whether kg/lbs)

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* Eye color

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* Hair color

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* Sex

Female

Male

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* Temporary address while at the conference site:

Address:

Address 2:

City/Town:

State:

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* Place of birth

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* Date of birth

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* Do you have a valid UN Grounds Pass?

Yes

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* Emergency Contact Information

Name:

Phone Number:

After clicking “done,” you will not be able to change your selections. If you would like to keep a record of this information, please print a copy of this screen before clicking “done.” A confirmation screen will appear- if you do not see the confirmation screen, contact UNA-USA membership staff to confirm that your responses were received.