23 CONS Base Pass Template.pdf

CONTROLLED UNCLASSIFIED INFORMATION

DEPARTMENT OF THE AIR FORCE 23D CONTRACTING

SQUADRON (ACC) MOODY AIR FORCE BASE GEORGIA

Attack ∙ Rescue ∙ Prevail The information herein is For Official Use Only (FOUO) which must be protected under the Freedom of Information Act of 1996 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in criminal and/or civil penalties

MEMORANDUM FOR 23 SFS/SFOXI

FROM: 23 CONS

SUBJECT: Request for Installation Access Personnel Pass

1. Request pass for the following person(s) to Moody AFB:

2. If you have any questions or concerns, please contact the undersigned:

Contract Number:

Prime Contractor:

Duration of Pass:

(NTE 1 Year)

Purpose:

Full Name Organization/CompanyDOB*

*Write N/A if contractor declined to provide information. Be advised that DOB information is required for base access.

Security Forces will ask for it at the Visitor's Center if not detailed in this form.

Sponsor Info: Rank, Name; Duty Title; Email; Duty Phone