Attach_12.pdf

LEGAL NAME OF GUEST

(NO NICKNAMES)

(List driver of the vehicle, then their passengers)

AGE DRIVERS LICENSE AND

STATE OF ISSUE

DATE OF BIRTH

(MM/DD/YYYY)

VEHICLE

LICENSE PLATE

AND STATE OF

ISSUE

DRIVER OF

VEHICLE

(YES / NO)

More instructions on the reverse of this form

IMPORTANT TIP: Please identify your guests by the driver of the vehicle first, then his/her passengers. This will allow us to put all personnel riding in the same vehicle on the pass, rather than having each individual guest receiving a pass for themselves. Doing this will save a substantial amount of time processing the request, and handing out passes on the day of the event.

NOTES: In order to ensure your guests are authorized entry to the base, this request must be hand-carried to the Pass and ID a minimum of SEVEN BUSINESS DAYS PRIOR TO THE EVENT. All visitors reguarless of age MUST be listed on this form. ONCE THE REQUEST IS DROPPED OFF, NO CHANGES WILL BE ALLOWED. The sponsor can then make arrangements to pick up the passes for his/her guests. The Pass and ID can be contacted at 722-1344 between the hours of 0800-1600 to check the status of your request.

TYPE OF EVENT:

DATE OF EVENT:

SPONSORS NAME:

SPONSORS UNIT:

All guests 16 years of age and older must have a valid STATE or FEDERALLY issued photo identification. No exceptions to this rule will be made.

This person must be able to come to the Visitors Center to assist on the day of the eventPOINT OF CONTACT FOR THE EVENT:

Seymour Johnson AFB SPECIAL EVENTS PASS REQUEST

PHONE NUMBER:

SPONSORS RANK:

START/STOP TIME OF EVENT:

LOCATION OF EVENT:

FA4809-14-R

HME 7 Page 1 of 2

FA4809-14-R-0001

Attachment 12, Page 1 of 1

To the Requester/Sponsor:

DISCLOSURE IS VOLUNTARY: Failure to disclose the requested information will result in denial of entry onto the installation

Again, this is to ensure your guests arrive at the event with minimal delays. We hope this helps to answer many of your questions. If you need any assistance, please feel free to contact Pass and ID Section at (919) 722-1344.

* If your guests are arriving in rental vehicles, please annotate that on the reverse of this form, in the "License Plate" column. The rental agreement showing the year, make and model of the vehicle being driven will be required upon arrival.

PRIVACY ACT STATEMENT

AUTHORITY: 10 USC 8013, 44 USC 3101, and EO 9397 PRINCIPAL PURPOSE: To record personal information to determine whether a pass should be issued to allow access to the installation ROUTINE USES: None

Advise your guests and their passengers of the following required criteria to enter Seymnour Johnson Air Force Base. To avoid any unnecessary delays, ensure they arrive at the Visitors Center in ample time to verify their documents (Drivers License, Vehcile Registration and Vehicle Insurance) and fill out their pass. All personnel in the vehicle must be listed on this listing, if the information is not correct, or is ommitted, access to the base will be d i d

4 SFS Special Events/Guest List

Please ensure you properly fill out this form in its entirety. All spaces must have the information requested. This is to assist your guests in gaining access to the base in a timely manner. There must be a point of contact positioned at the Visitors Center or available by telephone on the date of the event to prevent any difficulties (this must be someone who can respond, answer questions and has authority to sponsor guests onto the installation).

This form MUST be returned to us no later than a minimum of seven (7) business days prior to the event , if it is not, or any of the information is missing from any of the fields required, it will likely cause a delay in the guest's access to the installation. A background check will be completed on all of your guests, prior to being given access to the base.

We have requested you provide an event POC, someone with valid military ID/sponsorship abilities who is available on the day of your event, in case there are problems with passes. This person will be used to sponsor guests, who did not appear on your list correctly.

* Valid vehicle insurance for the vehicle being driven onto the base.

* Valid vehicle registration, if they will be driving a vehicle on the base.

* Any person 16 or above must posess a current and valid state drivers license, or state or federally issued photo identification card.

Your guests must meet the following:

FA4809-14-R-0001 ATTACHMENT 12 Page 2 of 2

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