Sect_L_App_1_-_KSC_Form_28-889_Visitor_Badge_Request.pdf

Please wait...

If this message is not eventually replaced by the proper contents of the document, your PDF viewer may not be able to display this type of document.

You can upgrade to the latest version of Adobe Reader for Windows®, Mac, or Linux® by visiting http://www.adobe.com/go/reader_download.

For more assistance with Adobe Reader visit http://www.adobe.com/go/acrreader.

Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc., registered in the United States and other countries. Linux is the registered trademark of Linus Torvalds in the U.S. and other countries.

KSC Visitor Badge Request (Multiple)

NRRS 1620.105.A

Page of KSC FORM 28-889 NS (PI) 08/13 (1.1) PREVIOUS EDITIONS ARE OBSOLETE. Validate prior to use.

Fax No. 867-4854 Mail Code: KSC Badging Office Phone No. 867-7763 Through signature above I attest to the validity and purpose of this visit.

FULL NAME (Last, First, MI)

COUNTRY OF CITIZENSHIP

SSN/Passport/Naturalization # or Alien Reg. # (Green Card) COMPANY NAME and ADDRESS

DATE OF BIRTH

PLACE OF BIRTH

START DATE

END DATE

To Be Escorted Y/N WARNING. When filled in, this form contains Personally Identifiable Information (PII) that is subject to Federal law and regulation. PII may be used only as authorized, which includes securing it in accordance with NASA policy and procedural requirements. Penalties for misuse apply.

Report suspected misuse immediately to Security Operations Center at 877-NASA-SEC (627-2732).

05/05/14 05/05/14 05/05/14 05/05/14 05/05/14 05/05/14 05/05/14 05/05/14 05/05/14 9.0.0.2.20101008.1.734229 KSC Visitor Badge Request (Multiple) KSC FORM 28-889 Rev 08/13, Created 08/13 Version 1.1 08/13 KSC Forms KSC Visitor Badge Request (Multiple) 08/13 1.1