Attach_07b_GAP blank form.pdf

Not Valid Without Original Signature & Stamp Access may be authorized by the Camp Commander or his/her designated representative ONLY

Version 04/2010 Adobe 8.0

Sponsor Name (スポンサー）(Last, First MI) Rank Duty Phone Unit/Organization

Citizenship Age (if<18)Last Name

Visitor (訪問者）

License PlateColorMake

Vehicle (車両）

Model

Purpose of Visit

* Persons under the age of 18 must be accompanied by their parent/guardian, or have in their possession a signed Permission Slip. 入域者が18歳未満の場合は保護者。ま たは世話人が同行するもしくは入域についての委任状が必要。* If number of visitors exceed space allotted, a separate request must be submitted for remaining group members. 入域者の人数が以下の欄に入らない場合は別紙に記載すること。* This form is not valid for Designated Third Country Nationals (USFJI 31-204). この書式 は指定された第3国の者には適用されない・ * Individuals must possess a suitable means of identification while on or attempting to gain access to the area(s) listed herein. Failure to do so may result in the denial of access or removal from the area. 入域者はここに記載されている場所に入域する、又はしている間は身分証明書 を形態すること。これに反した場合、入域を却下されたり、又は退去を命じられることもある。

MCBJ GROUP ACCESS PASS ESCORTED ACCESS ONLY（ｴｽｺｰﾄが必要）

First Name

Gate(s) Authorized（通行許可されたゲート）Dates Authorized（期間） to to

Times Authorized（時間）

Dates/Times Requested Gates Requested

DO NOT MARK BELOW THIS LINE

As the sponsor, I understand the guidelines below and that I am responsible for my guests' conduct at ALL times while aboard the installation.

Sponsor Signature

Destination

Approval Signature(米軍側サイン

Kinser Foster/Lester Courtney/McTureous Hansen Schwab Futenma

ADMIN NO.

FORM MUST BE TYPED - NO ADDITIONS WILL BE ACCEPTED ONCE APPROVED

mamoru.uriu.ja Typewritten Text mamoru.uriu.ja Typewritten Text

Not Valid Without Original Signature & Stamp Access may be authorized by the Camp Commander or his/her designated representative ONLY

Version 04/2010 Adobe 8.0 Citizenship Age (if<18) Last Name Visitor (訪問者） License Plate Color Make Vehicle (車両） Model

* Persons under the age of 18 must be accompanied by their parent/guardian, or have in their possession a signed Permission Slip. 入域者が18歳未満の場合は保護者。または世話人が同行するもしくは入域についての委任状が必要。* If number of visitors exceed space allotted, a separate request must be submitted for remaining group members. 入域者の人数が以下の欄に入らない場合は別紙に記載すること。* This form is not valid for Designated Third Country Nationals (USFJI 31-204). この書式は指定された第3国の者には適用されない・ * Individuals must possess a suitable means of identification while on or attempting to gain access to the area(s) listed herein. Failure to do so may result in the denial of access or removal from the area. 入域者はここに記載されている場所に入域する、又はしている間は身分証明書を形態すること。これに反した場合、入域を却下されたり、又は退去を命じられることもある。

MCBJ GROUP ACCESS PASS ESCORTED ACCESS ONLY（ｴｽｺｰﾄが必要）

First Name Gate(s) Authorized（通行許可されたゲート） Dates Authorized（期間） to to Times Authorized（時間）

DO NOT MARK BELOW THIS LINE

As the sponsor, I understand the guidelines below and that I am responsible for my guests' conduct at ALL times while aboard the installation.

ADMIN NO.

FORM MUST BE TYPED - NO ADDITIONS WILL BE ACCEPTED ONCE APPROVED

8.0.1291.1.339988.308172