Attachment_7_-_Site_Visit_Registration_Form.doc

CONTRACTOR SITE VISIT REGISTRATION FORM

INSTRUCTIONS: Please complete and return this form to A1C Lydia Simpkins/Capt Hilary Ince by no later than COB on 25 April 2017, if you wish to attend the site visit. Completed forms must be submitted to the following address. Completed forms must also be sent via e-mail to lydia.simpkins@us.af.mil AND hilary.ince@us.af.mil.

Address:

7th Contracting Squadron

Attn: AIC Lydia Simpkins/Capt Hilary Ince

381 Third Street Bldg. 7238

Dyess AFB TX 79607

Name & Address of Firm:

Point of Contact: ___________________________________

E-Mail Address: ____________________________________ Phone No.: _______________ Number of individuals to attend the contractor site visit: ____

CONTRACTOR/VENDOR LIST

Name of Prime Contractor:

Name of Sub Contractor:

Contract For/or Type of Service:

Contract Number:

Start Date:

Completion Date:

Duty Phone:

Vouch

Y or N

YY/MM/DD

N

N

N

N

N

N

N

N

N

The above information is correct to the best of my knowledge. The contractor or designated employee must sign, date and print name in signature block below.

Printed Name:

Signature:

Date:

SPONSOR INFORMATION ONLY:

NO

HOURS

By signing below I certify that I have a DD Form 557 (Signature Card) on file at Pass & Registration. (Ext 696-3088)

Printed Name:

Signature:

Date:

Privacy Act Statement

Information contained herein is personal and will not be disclosed to the public without permission of the individual, IAW AFI 37-312. DYESS FORM 173