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HUES 55th Annual Meeting Registration Form September 19 23, 2011, Las Vegas, Nevada, USA 9 Human Factors and Ergonomics Society 55th Annual Meeting Please complete BOTH pages of this form. Early registration

Once we confirm your registration, you will receive a confirmation number from HUES. You must have a valid e-mail account to receive your confirmation. If you do not receive your confirmation number by 5:00 p.m. CDT on September 9, you will not be registered. We regret that we cannot accept phone or fax cancellations. We will issue registration confirmation and confirmations via e-mail as soon as we have confirmed your purchase and confirmation of your date of attendance. Required field. Name First Last Title Company/Organization Address City State/Province/Country AK — Alaska AL — Alabama AR — Arkansas AZ — Arizona CA — California CO — Colorado CT — Connecticut DC — District of Columbia DE — Delaware FL — Florida GA — Georgia HI — Hawaii IA — Iowa ID — Idaho IL — Illinois IN — Indiana KS — Kansas KY — Kentucky LA — Louisiana MA — Massachusetts MD — Maryland ME — Maine MI — Michigan MN — Minnesota MO — Missouri MS — Mississippi MT — Montana NC — North Carolina ND — North Dakota NE — Nebraska NH — New Hampshire NJ — New Jersey NM — New Mexico NV — Nevada NY — New York OH — Ohio OK — Oklahoma OR — Oregon PA — Pennsylvania RI — Rhode Island SC — South Carolina SD — South Dakota TN — Tennessee TX — Texas VA — Virginia VT — Vermont WA — Washington WI — Wisconsin WV — West Virginia WY — Wyoming AS — American Samoa FM — Federated States of Micronesia GU — Guam MH — Marshall Islands MP — Northern Mariana Islands PR — Puerto Rico PW — Paley VI — Virgin Islands AA — Armed Forces Americas AE — Armed Forces AP — Armed Forces Pacific AB — Alberta BC — British Columbia MB — Manitoba NB — New Brunswick NL — Newfoundland and Labrador NS — Nova Scotia NT — Northwest Territories NU — Nunavut ON — Ontario PE — Prince Edward Island QC — Quebec SK — Saskatchewan YT — Yukon None Street City --Select-- Abbotsford Calgary Edmonton Fredericton Halifax Moncton Peterborough Regina Saint John Sudbury Toronto None Email Address Password Confirm Password I acknowledge that my registration information, including my first, middle, and last name, date of birth or citizenship, and email address will only be used for communications to the HUES, and will be kept confidential.

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