Atch 1 - NSSL Ph3 Industry Day Participant Request Form.pdf

NSSL Industry Day Participant Request Form

Date and Time:

28 February 2023:

- General Session: 0800-1200 PDT

- One-on-One Sessions: 1300-1600 PDT

1 March 2023: One-on-One Sessions (if necessary)

Location:

Space Systems Command Gordon Conference Center (GCC) 483 North Aviation Blvd El Segundo, CA, 90245

Company Name:

Company POC:

(name/email)

Identify In Person Participants for Industry Day (Maximum of 5):

Full Name: Last, First, Middle Date of Birth Driver’s License / State Last 4 SSN

1.

2.

3.

4.

5.

(Please note any non-U.S. Citizens will not be allowed to attend this Industry Day)

Please adhere to the example below when entering In Person Participant information:

NOTE: We cannot accept driver’s license or state IDs that indicate “FEDERAL LIMITS APPLY” per REAL ID ACT of 2005. A person in possession of such document must have another form of picture identification such as a US passport. People listed MUST be US Citizens.

Last Name, First Name, Middle Name: SCOTT, TYLER ROBERT (NOT BOB)

Date of Birth: MONTH/DAY/YEAR (Ex: 06/28/1978)

Driver’s License Number and State: All Numbers, Letters and State of Issuance must be included (Ex: X01234567 CA).

Last 4 of Social Security Number (SSN): Mandatory for All In Person Participants

Potential Phase 3 Launch Service Providers One-on-One Session:

The Government considers a potential Phase 3 Launch Service Provider to be any space access company with an existing and/or planned launch system capable of lifting a NSSL-class payload to orbit.

Check box if requesting a One-on-One discussion after the general session?

Additional Comments:

Please fill out and return this form to Mr. Greg Pierson at gregory.pierson@spaceforce.mil and Capt Foster Davis at foster.davis@spaceforce.mil no later than 1300 PDT on 21 February 2023.