AVRE Strategic Workshop Registration Sandia National Laboratories invites you to register to attend the AVRE Strategic Workshop. Personal Information Please provide your full legal name as it appears on your government ID. First Name Middle Name(s) Last Name Sex No valuefemalemale Moble/Cell Phone Your E-Mail Address Do you have a medically necessary electronic device? Medical necessary [electronic] devices, such as hearing aids or pacemakers, require special processing for access into ALL limited areas and secured spaces. It is imperative you work with your point of contact to coordinate a MedPED request with the appropriate approving authority. This can take up to one month to process with multiple reviews. yes no Badging and Clearance Information Because much of Sandia’s mission involves national security, entry is strictly regulated. Access to Sandia-controlled premises and Kirtland Air Force Base (KAFB) are separate matters and need to be handled appropriately. Except for a few public areas, a DOE security badge (i.e., DOE HSPD-12 credential or Sandia-issued visitor badge) is required for access to all Sandia-controlled premises. A state-issued driver’s license or ID card issued by REAL ID compliant states is required in order to receive your badge. Date of Birth Enter a date in the format YYYY-MM-DD Do you have a DOE HSPD-12 Badge? yes no Social Security Number If you have been to Sandia National Laboratories in the past, please provide ONLY the last four digits of your SSN. If you have not been to Sandia National Laboratories, please provide your full SSN. Birth City Birth State Birth Country Country/Countries of Citizenship Kirtland Air Force Base Access For those who do not carry a CAC or an existing DBIDS card, access to Kirtland Air Force Base requires additional information. Please provide your Drivers License number and issuing state. Do you have an existing DBIDS card or CAC card for entrance to Kirtland Air Force Base? yes no Driver's License Number THIS IS ONLY REQUIRED IF YOU DO NOT HAVE AN EXISTING KAFB DBIDS CARD Driver's License Issuing State THIS IS ONLY REQUIRED IF YOU DO NOT HAVE AN EXISTING KAFB DBIDS CARD Employment Information Job Title Company Name Company Address Company City Company State Company Zip Code Business Phone Event Information Name Tag Information Please enter how you would like your name to appear on your name tag/tent card. Dietary or Event Accomodations Request Please let us know if you have other dietary requests or special event considerations.