Industry_Day_Registration_Form.doc

ALC Industry Day November 5, 2012 Registration Form To all potential sources wishing to participate in the upcoming Industry Day regarding the Long Range Surveillance (LRS) Progressive Structural Inspection (PSI) and depot level repair of its HC-130H and HC-130J aircraft, identify below your company information and provide a list of participants you will be sending to represent you. Attendees will be required to present a CURRENT photo ID (driver’s license, military ID, company ID or passport), current vehicle registration card and proof of insurance upon check-in. Only authorized personnel may access the base and if an individual is not listed below, they will not gain entry.

Company Name:

POC Name and Phone Number:

POC e-mail:

Company Address:

CAGE Code:

Business Size (Circle one): Small (<1500 employees) or Large If you represent a small business, is the business (check all that apply)

__ a socially and economically disadvantaged business;

__ an 8(a) firm;

__ HUBzone;

__ a woman-owned business;

__ veteran-owned small business;

__ service-disabled veteran-owned;

Attendee(s):

Guest Name

Drivers License No.

Date of Birth US Citizen

Contact Ms. Sherri Peele, 252-335-6768 or email sherri.l.peele@uscg.mil if you require further information. Date: November 5, 2012, Time: 9:00am Eastern Time, Location: USCG Aviation Technical Training Center, 1664 Weeksville Rd., Bldg. 4, Elizabeth City, NC 27909 (Multi Purpose Room).

Visitor request form is shall be completed and forwarded to sherri.l.peele@uscg.mil by October 25, 2012, 4:00pm Eastern Time.