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Submitted URL: https://govexc.omeclk.com/portal/wts/uemcnBqkkaeknLjEv6rfEP*7Cd
Effective URL: https://events.fcw.com/digital-revolution/registration/?promo_source=EM11
Submission: On April 15 via manual from US — Scanned from DE
Effective URL: https://events.fcw.com/digital-revolution/registration/?promo_source=EM11
Submission: On April 15 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST ./?promo_source=EM11
<form id="digital-revolution-registration" class="form" method="post" enctype="multipart/form-data" action="./?promo_source=EM11">
<div class="forms-field-container">
<input type="hidden" name="csrfmiddlewaretoken" value="7NN9wKQZywKsNSz0TLUmJQGQoeGu5e1mjlbOj1egnKZJ0Ri43H2a74eDy1a5QEio">
<div class="forms-field field-wrapper form-group textinput
">
<label class="forms-field-label" for="id_first_name"> First Name <span class="forms-required-label">*</span>
</label>
<input type="text" name="first_name" data-id="3029" data-required="true" autocomplete="on" required="" id="id_first_name">
</div>
<div class="forms-field field-wrapper form-group textinput
">
<label class="forms-field-label" for="id_last_name"> Last Name <span class="forms-required-label">*</span>
</label>
<input type="text" name="last_name" data-id="3030" data-required="true" autocomplete="on" required="" id="id_last_name">
</div>
<div class="forms-field field-wrapper form-group textinput
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<label class="forms-field-label" for="id_email"> Email <span class="forms-required-label">*</span>
</label>
<input type="text" name="email" data-id="2538" data-required="true" autocomplete="email" required="" id="id_email">
</div>
<div class="forms-field field-wrapper form-group select
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<label class="forms-field-label" for="id_employer_category"> Employer <span class="forms-required-label">*</span>
</label>
<select name="employer_category" data-id="2534" data-required="true" required="" id="id_employer_category">
<option value="" selected="">(Choose One)</option>
<option value="1">Department of Defense (Civilian)</option>
<option value="2">Department of Defense (Military)</option>
<option value="3">Federal Government</option>
<option value="4">State/Local Government</option>
<option value="5">Government Contractor</option>
<option value="6">Academia</option>
<option value="7">Media</option>
<option value="8">Non Profit</option>
<option value="9">Private Sector</option>
<option value="10">Retired</option>
</select>
</div>
<div class="forms-field field-wrapper form-group select
" style="display: none;">
<label class="forms-field-label" for="id_department_0"> Agency/Department <span class="forms-required-label">*</span>
</label>
<input type="hidden" name="department_0" data-initial="null" data-required="true" required="" id="id_department_0" value=""><select name="department_1" data-group-id="null" data-id="2539" data-required="true" id="id_department_1"
disabled="disabled" required="">
<option value="" selected="">(Choose One)</option>
<option value="11">Department of Agriculture</option>
<option value="12">Department of Commerce</option>
<option value="13">Department of Education</option>
<option value="14">Department of Energy</option>
<option value="15">Department of Defense </option>
<option value="16">Department of HHS</option>
<option value="17">Department of Homeland Security</option>
<option value="18">Department of HUD</option>
<option value="19">Department of Interior</option>
<option value="20">Department of Justice</option>
<option value="21">Department of Labor</option>
<option value="22">Department of State</option>
<option value="23">Department of Transportation</option>
<option value="24">Department of Treasury</option>
<option value="25">Department of Veterans Affairs</option>
<option value="26">EPA</option>
<option value="27">Executive Office of the President/Vice President</option>
<option value="28">Federal Bureau of Investigation</option>
<option value="29">Federal Communications Commission</option>
<option value="30">Federal Trade Commission</option>
<option value="31">GSA</option>
<option value="32">Judiciary Branch</option>
<option value="33">Legislative Branch</option>
<option value="34">NASA</option>
<option value="35">National Institutes of Health</option>
<option value="36">OMB</option>
<option value="37">OPM</option>
<option value="38">SSA</option>
<option value="39">USPS</option>
<option value="40">County</option>
<option value="41">Government Association</option>
<option value="42">Municipal</option>
<option value="43">Special District</option>
<option value="44">State</option>
<option value="45">Army</option>
<option value="46">Air Force</option>
<option value="47">Coast Guard</option>
<option value="48">Marines</option>
<option value="49">Navy</option>
<option value="50">Department of the Air Force</option>
<option value="51">Department of the Army</option>
<option value="52">Department of the Navy</option>
<option value="53">Joint Chiefs of Staff</option>
<option value="54">Defense Intelligence Agency</option>
<option value="55">Office of the Secretary of Defense</option>
<option value="56">Other Defense Agency</option>
<option value="57">Other Agency</option>
<option value="58">Higher Education</option>
<option value="59">K-12 Education</option>
<option value="60">Space Force</option>
<option value="61">Department of Space Force</option>
</select><select name="department_2" data-group-id="1" data-id="2539" data-required="true" id="id_department_2" disabled="disabled" style="display: none;">
<option value="" selected="">(Choose One)</option>
<option value="11">Department of Agriculture</option>
<option value="12">Department of Commerce</option>
<option value="13">Department of Education</option>
<option value="14">Department of Energy</option>
<option value="16">Department of HHS</option>
<option value="17">Department of Homeland Security</option>
<option value="18">Department of HUD</option>
<option value="19">Department of Interior</option>
<option value="20">Department of Justice</option>
<option value="21">Department of Labor</option>
<option value="22">Department of State</option>
<option value="23">Department of Transportation</option>
<option value="24">Department of Treasury</option>
<option value="25">Department of Veterans Affairs</option>
<option value="26">EPA</option>
<option value="27">Executive Office of the President/Vice President</option>
<option value="28">Federal Bureau of Investigation</option>
<option value="29">Federal Communications Commission</option>
<option value="30">Federal Trade Commission</option>
<option value="31">GSA</option>
<option value="32">Judiciary Branch</option>
<option value="33">Legislative Branch</option>
<option value="34">NASA</option>
<option value="35">National Institutes of Health</option>
<option value="36">OMB</option>
<option value="37">OPM</option>
<option value="38">SSA</option>
<option value="39">USPS</option>
<option value="57">Other Agency</option>
</select><select name="department_3" data-group-id="2" data-id="2539" data-required="true" id="id_department_3" disabled="disabled" style="display: none;">
<option value="" selected="">(Choose One)</option>
<option value="45">Army</option>
<option value="46">Air Force</option>
<option value="47">Coast Guard</option>
<option value="48">Marines</option>
<option value="49">Navy</option>
<option value="60">Space Force</option>
</select><select name="department_4" data-group-id="3" data-id="2539" data-required="true" id="id_department_4" disabled="disabled" style="display: none;">
<option value="" selected="">(Choose One)</option>
<option value="50">Department of the Air Force</option>
<option value="51">Department of the Army</option>
<option value="52">Department of the Navy</option>
<option value="53">Joint Chiefs of Staff</option>
<option value="54">Defense Intelligence Agency</option>
<option value="55">Office of the Secretary of Defense</option>
<option value="56">Other Defense Agency</option>
<option value="61">Department of Space Force</option>
</select><select name="department_5" data-group-id="4" data-id="2539" data-required="true" id="id_department_5" disabled="disabled" style="display: none;">
<option value="" selected="">(Choose One)</option>
<option value="40">County</option>
<option value="41">Government Association</option>
<option value="42">Municipal</option>
<option value="43">Special District</option>
<option value="44">State</option>
<option value="58">Higher Education</option>
<option value="59">K-12 Education</option>
</select><select name="department_6" data-group-id="5" data-id="2539" data-required="true" id="id_department_6" disabled="disabled" style="display: none;">
<option value="" selected="">(Choose One)</option>
<option value="11">Department of Agriculture</option>
<option value="12">Department of Commerce</option>
<option value="13">Department of Education</option>
<option value="14">Department of Energy</option>
<option value="16">Department of HHS</option>
<option value="17">Department of Homeland Security</option>
<option value="18">Department of HUD</option>
<option value="20">Department of Justice</option>
<option value="21">Department of Labor</option>
<option value="23">Department of Transportation</option>
<option value="24">Department of Treasury</option>
<option value="25">Department of Veterans Affairs</option>
<option value="26">EPA</option>
<option value="32">Judiciary Branch</option>
<option value="33">Legislative Branch</option>
<option value="57">Other Agency</option>
</select><select name="department_7" data-group-id="6" data-id="2539" data-required="true" id="id_department_7" disabled="disabled" style="display: none;">
<option value="" selected="">(Choose One)</option>
<option value="11">Department of Agriculture</option>
<option value="12">Department of Commerce</option>
<option value="13">Department of Education</option>
<option value="14">Department of Energy</option>
<option value="15">Department of Defense </option>
<option value="16">Department of HHS</option>
<option value="17">Department of Homeland Security</option>
<option value="18">Department of HUD</option>
<option value="19">Department of Interior</option>
<option value="20">Department of Justice</option>
<option value="21">Department of Labor</option>
<option value="22">Department of State</option>
<option value="23">Department of Transportation</option>
<option value="24">Department of Treasury</option>
<option value="25">Department of Veterans Affairs</option>
<option value="26">EPA</option>
<option value="31">GSA</option>
<option value="32">Judiciary Branch</option>
<option value="33">Legislative Branch</option>
<option value="34">NASA</option>
<option value="36">OMB</option>
<option value="37">OPM</option>
<option value="38">SSA</option>
<option value="39">USPS</option>
<option value="55">Office of the Secretary of Defense</option>
<option value="57">Other Agency</option>
</select>
</div>
<div class="forms-field field-wrapper form-group textinput
" style="display: none;">
<label class="forms-field-label" for="id_organization"> Organization <span class="forms-required-label">*</span>
</label>
<input type="text" name="organization" data-id="2540" data-required="true" autocomplete="on" id="id_organization" disabled="disabled">
</div>
<div class="forms-field field-wrapper form-group select
" style="display: none;">
<label class="forms-field-label" for="id_organization-function_0"> Organization Function </label>
<input type="hidden" name="organization-function_0" data-initial="null" id="id_organization-function_0" value=""><select name="organization-function_1" data-group-id="null" data-id="2674" id="id_organization-function_1" disabled="disabled">
<option value="" selected="">(Choose One)</option>
<option value="248">Elected Official/Legislative/Executive Office</option>
<option value="249">Environment/Energy</option>
<option value="250">Finance/Budget</option>
<option value="251">Health & Human Services</option>
<option value="252">Public Safety/Emergency Services/Law Enforcement</option>
<option value="253">Technology</option>
<option value="254">Transportation/Utilities/Infrastructure</option>
<option value="256">Other</option>
</select><select name="organization-function_2" data-group-id="11" data-id="2674" id="id_organization-function_2" disabled="disabled" style="display: none;">
<option value="" selected="">(Choose One)</option>
<option value="248">Elected Official/Legislative/Executive Office</option>
<option value="249">Environment/Energy</option>
<option value="250">Finance/Budget</option>
<option value="251">Health & Human Services</option>
<option value="252">Public Safety/Emergency Services/Law Enforcement</option>
<option value="253">Technology</option>
<option value="254">Transportation/Utilities/Infrastructure</option>
<option value="256">Other</option>
</select>
</div>
<div class="forms-field field-wrapper form-group textinput
">
<label class="forms-field-label" for="id_phone"> Phone Number <span class="forms-required-label">*</span>
</label>
<input type="text" name="phone" data-id="2544" data-required="true" autocomplete="tel" required="" id="id_phone">
</div>
<div class="forms-field field-wrapper form-group textinput
">
<label class="forms-field-label" for="id_job_title"> Job Title <span class="forms-required-label">*</span>
</label>
<input type="text" name="job_title" data-id="2541" data-required="true" autocomplete="on" required="" id="id_job_title">
</div>
<div class="forms-field field-wrapper form-group select
" style="display: none;">
<label class="forms-field-label" for="id_grade_0"> Grade/Rank <span class="forms-required-label">*</span>
</label>
<input type="hidden" name="grade_0" data-initial="null" data-required="true" required="" id="id_grade_0" value=""><select name="grade_1" data-group-id="null" data-id="2542" data-required="true" id="id_grade_1" disabled="disabled" required="">
<option value="" selected="">(Choose One)</option>
<option value="62">SES</option>
<option value="63">GS-15</option>
<option value="64">GS-14</option>
<option value="65">GS-13</option>
<option value="66">GS-12</option>
<option value="67">GS-11</option>
<option value="68">GS-10</option>
<option value="69">GS-9 and below</option>
<option value="70">O1</option>
<option value="71">O2</option>
<option value="72">O3</option>
<option value="73">O4</option>
<option value="74">O5</option>
<option value="75">O6</option>
<option value="76">O7</option>
<option value="77">O8</option>
<option value="78">O9</option>
<option value="79">O10</option>
<option value="80">E1</option>
<option value="81">E2</option>
<option value="82">E3</option>
<option value="83">E4</option>
<option value="84">E5</option>
<option value="85">E6</option>
<option value="86">E7</option>
<option value="87">E8</option>
<option value="88">E9</option>
<option value="89">E10</option>
<option value="90">Not Applicable</option>
</select><select name="grade_2" data-group-id="7" data-id="2542" data-required="true" id="id_grade_2" disabled="disabled" style="display: none;">
<option value="" selected="">(Choose One)</option>
<option value="62">SES</option>
<option value="63">GS-15</option>
<option value="64">GS-14</option>
<option value="65">GS-13</option>
<option value="66">GS-12</option>
<option value="67">GS-11</option>
<option value="68">GS-10</option>
<option value="69">GS-9 and below</option>
</select><select name="grade_3" data-group-id="8" data-id="2542" data-required="true" id="id_grade_3" disabled="disabled" style="display: none;">
<option value="" selected="">(Choose One)</option>
<option value="70">O1</option>
<option value="71">O2</option>
<option value="72">O3</option>
<option value="73">O4</option>
<option value="74">O5</option>
<option value="75">O6</option>
<option value="76">O7</option>
<option value="77">O8</option>
<option value="78">O9</option>
<option value="79">O10</option>
<option value="80">E1</option>
<option value="81">E2</option>
<option value="82">E3</option>
<option value="83">E4</option>
<option value="84">E5</option>
<option value="85">E6</option>
<option value="86">E7</option>
<option value="87">E8</option>
<option value="88">E9</option>
<option value="89">E10</option>
</select><select name="grade_4" data-group-id="9" data-id="2542" data-required="true" id="id_grade_4" disabled="disabled" style="display: none;">
<option value="" selected="">(Choose One)</option>
<option value="62">SES</option>
<option value="63">GS-15</option>
<option value="64">GS-14</option>
<option value="65">GS-13</option>
<option value="66">GS-12</option>
<option value="67">GS-11</option>
<option value="68">GS-10</option>
<option value="69">GS-9 and below</option>
</select>
</div>
<div class="forms-field field-wrapper form-group select
">
<label class="forms-field-label" for="id_job_function_0"> Job Function <span class="forms-required-label">*</span>
</label>
<input type="hidden" name="job_function_0" data-initial="null" data-required="true" required="" id="id_job_function_0" value=""><select name="job_function_1" data-group-id="null" data-id="2543" data-required="true" required=""
id="id_job_function_1">
<option value="" selected="">(Choose One)</option>
<option value="91">Agency Leadership</option>
<option value="92">Business & Operations</option>
<option value="93">Communications & Marketing</option>
<option value="94">Financial/Contract Management</option>
<option value="95">Human Resource Management</option>
<option value="96">Technology Management</option>
</select><select name="job_function_2" data-group-id="10" data-id="2543" data-required="true" id="id_job_function_2" style="display: none;">
<option value="" selected="">(Choose One)</option>
<option value="92">Business & Operations</option>
<option value="93">Communications & Marketing</option>
<option value="94">Financial/Contract Management</option>
<option value="95">Human Resource Management</option>
<option value="96">Technology Management</option>
</select>
</div>
<div class="forms-field field-wrapper form-group textinput
">
<label class="forms-field-label" for="id_city"> City <span class="forms-required-label">*</span>
</label>
<input type="text" name="city" data-id="2734" data-required="true" autocomplete="on" required="" id="id_city">
</div>
<div class="forms-field field-wrapper form-group select
">
<label class="forms-field-label" for="id_state"> State <span class="forms-required-label">*</span>
</label>
<select name="state" data-id="2546" data-required="true" required="" id="id_state">
<option value="" selected="">(Choose One)</option>
<option value="97">Alabama</option>
<option value="98">Alaska</option>
<option value="99">Arizona</option>
<option value="100">Arkansas</option>
<option value="101">California</option>
<option value="102">Colorado</option>
<option value="103">Connecticut</option>
<option value="104">Delaware</option>
<option value="105">District of Columbia</option>
<option value="106">Florida</option>
<option value="107">Georgia</option>
<option value="108">Guam</option>
<option value="109">Hawaii</option>
<option value="110">Idaho</option>
<option value="111">Illinois</option>
<option value="112">Indiana</option>
<option value="113">Iowa</option>
<option value="114">Kansas</option>
<option value="115">Kentucky</option>
<option value="116">Louisiana</option>
<option value="117">Maine</option>
<option value="118">Maryland</option>
<option value="119">Massachusetts</option>
<option value="120">Michigan</option>
<option value="121">Minnesota</option>
<option value="122">Mississippi</option>
<option value="123">Missouri</option>
<option value="124">Montana</option>
<option value="125">Nebraska</option>
<option value="126">Nevada</option>
<option value="127">New Hampshire</option>
<option value="128">New Jersey</option>
<option value="129">New Mexico</option>
<option value="130">New York</option>
<option value="131">North Carolina</option>
<option value="132">North Dakota</option>
<option value="133">Ohio</option>
<option value="134">Oklahoma</option>
<option value="135">Oregon</option>
<option value="136">Pennsylvania</option>
<option value="137">Puerto Rico</option>
<option value="138">Rhode Island</option>
<option value="139">South Carolina</option>
<option value="140">South Dakota</option>
<option value="141">Tennessee</option>
<option value="142">Texas</option>
<option value="143">Utah</option>
<option value="144">Vermont</option>
<option value="145">Virgin Islands</option>
<option value="146">Virginia</option>
<option value="147">Washington</option>
<option value="148">West Virginia</option>
<option value="149">Wisconsin</option>
<option value="150">Wyoming</option>
<option value="151">Overseas Europe (AE)</option>
<option value="152">Overseas Pacific (AP)</option>
</select>
</div>
<div class="forms-field field-wrapper form-group textinput
">
<label class="forms-field-label" for="id_zip_code"> Zip Code <span class="forms-required-label">*</span>
</label>
<input type="text" name="zip_code" data-id="2547" data-required="true" autocomplete="on" required="" id="id_zip_code">
</div>
<div class="forms-field field-wrapper form-group select
">
<label class="forms-field-label" for="id_country"> Country <span class="forms-required-label">*</span>
</label>
<select name="country" data-id="2548" data-required="true" required="" id="id_country">
<option value="" selected="">(Choose One)</option>
<option value="153">United States</option>
<option value="154">EEA (European Economic Area)</option>
<option value="155">Canada</option>
<option value="156">Other</option>
</select>
</div>
<div class="forms-field field-wrapper form-group textinput
" style="display: none;">
<label class="forms-field-label" for="id_country_other"> Country (Other) <span class="forms-required-label">*</span>
</label>
<input type="text" name="country_other" data-id="2549" data-required="true" autocomplete="country-name" id="id_country_other" disabled="disabled">
</div>
<div class="forms-field field-wrapper form-group checkboxinput
">
<label class="forms-field-label" for="id_wt-insider"> Check this box if you are a Washington Technology Insider </label>
<input type="checkbox" name="wt-insider" data-id="2675" id="id_wt-insider">
</div>
<div class="forms-field field-wrapper form-group textarea
" style="display: none;">
<label class="forms-field-label" for="id_wt-insider-number"> Enter your WT Insider Membership Number here and use the coupon code FCW_WTinsider to register for a discounted rate. Note: To receive Insider pricing, you must register with the
email address associated with your current WT Insider subscription. </label>
<textarea name="wt-insider-number" cols="40" rows="4" data-id="2676" id="id_wt-insider-number" disabled="disabled"></textarea>
</div>
<div class="forms-field field-wrapper form-group checkboxinput
">
<label class="forms-field-label" for="id_ada"> Do you have any ADA requirements? </label>
<input type="checkbox" name="ada" data-id="2550" rows="4" id="id_ada">
</div>
<div class="forms-field field-wrapper form-group textinput
" style="display: none;">
<label class="forms-field-label" for="id_ada_req"> Please list your ADA requirements and email Loren Beasley at LBEASLEY@GOVEXEC.COM to confirm <span class="forms-required-label">*</span>
</label>
<input type="text" name="ada_req" data-id="2551" rows="4" data-required="true" autocomplete="on" id="id_ada_req" disabled="disabled">
</div>
<div class="forms-field field-wrapper form-group checkboxselectmultiple
">
<label class="forms-field-label" for=""> Select the newsletters you wish to receive </label>
<div class="checkbox">
<ul id="id_fcw_newsletter">
<li><label for="id_fcw_newsletter_0"><input type="checkbox" name="fcw_newsletter" value="215" data-id="2552" rows="4" id="id_fcw_newsletter_0"> FCW Daily</label>
</li>
<li><label for="id_fcw_newsletter_1"><input type="checkbox" name="fcw_newsletter" value="238" data-id="2552" rows="4" id="id_fcw_newsletter_1"> Defense Systems Update</label>
</li>
<li><label for="id_fcw_newsletter_2"><input type="checkbox" name="fcw_newsletter" value="239" data-id="2552" rows="4" id="id_fcw_newsletter_2"> Washington Technology Insider</label>
</li>
<li><label for="id_fcw_newsletter_3"><input type="checkbox" name="fcw_newsletter" value="240" data-id="2552" rows="4" id="id_fcw_newsletter_3"> GCN Insider: AI & Automation</label>
</li>
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