U.S. Citizen Registration

Deadline for submission is February 7, 2025.

*PII* Sandia Proprietary (when submitted)

Personal Information

First Name  

Middle Name  

Last Name  

Gender  

femalemaleother

Date of Birth   Enter a date in the format MM-DD-YYYY

Birth Country  

Birth State  

Birth City/Location  

Do you have a DOE HSPD-12 Badge?  

noyes

Social Security Number   Please provide your full SSN as this is a requirement for SNL Badging and Access.

Do you have an active Military CAC card?  

yes no

Driver's License Number   If your Driver's License number begins with a zero (0) please place an * in front of the number.

Driver's License Issuing State  

Employment Information

Job Title  

Company Name  

Company Address 1  

Company Address 2

Company City  

Company State  

Company Zip Code  

Business Phone

Mobile/Cell Phone  

Your E-Mail Address  

Name Tag Information   How your name will appear on your name tag

Do you have any special dietary needs?  

None Gluten Free Vegetarian Lactose Intolerant Vegan Nut allergy Kosher Halal

Are you an Observer, Participant or Instructor (select one)  

ObserverParticipantInstructor

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