Attachment_I_NAS_FORT_WORTH_JRB_DARF_BLANK.pdf

SPONSOR NAME:

RANK / GRADE: SPONSOR TELEPHONE: Alt. Contact Number:

DATE OF ARRIVAL: TIME OF ARRIVAL: DURATION OF VISIT:

ACCESS RESTRICTIONS / OTHER INFORMATION:

DESTINATION:

DIGITAL VISITOR ACCESS REQUEST

FOR NAS FORT WORTH JRB INTERNAL USE ONLY

REDISTRIBUTION OF THIS DOCUMENT

WITHOUT PRIOR AUTHORIZATION IS PROHIBITED

By emailing this Digital Visitor Access Request to the NAS FORT WORTH JRB Visitor Center you are affixing your CAC digital signature to the email message and this document. In doing so you affirm that you are the authorized user of the CAC and email account used to transmit this document, and that your official status includes the privilege to sponsor the named visitor(s) onto NAS FORT WORTH JRB for the purpose stated in this document.

Select a Specific Number of Consecutive Calendar Days Access To Include Date of Arrival

NAME OF VISITOR(S) -- AS PRESENT ON IDENTIFICATION PRESENTED TO BASE PERSONNEL

COMPANY NAME IS REQUIRED FOR BUSINESS GUESTS

PLEASE CHECK NAME SPELLING. MISSPELLED NAMES CAN NOT BE FOUND WHEN SEARCHING FOR YOUR GUEST.

NASFTWOJRB PID REV 20140521

US GOVERNMENT SPONSOR'S DIGITAL SIGNATURE

HELP US EXPEDITE YOUR REQUEST

Business Sponsorship: List your guest(s) and the company they represent.

THIS IS REQUIRED

Event Sponsorship: Use an event name your guests will communicate to our gate guards. This helps the guards locate your list.

Minor children in the company of an adult guardian need not be listed.

Need Help? Pass Office Contact Number: 817-782-3058

NAS FORT WORTH JRB VISITOR CONTROL CENTER

SPONSORING COMMAND /

ACTIVITY / EVENT NAME:

CNICINST 5530.14A 29 May 2013 requires that all persons requesting unescorted access be vetted by the Security Department, to include Sex Offender Registration and Notification Act of 2006 (SORNA) and National Crime Information Center (NCIC) checks.