NEW Visitor's Pre-Announcement Notification LRETD.pdf

DEPARTMENT OF THE AIR FORCE

AIR FORCE RESEARCH LABORATORY

EDWARDS AIR FORCE BASE CALIFORNIA 93524

MEMORANDUM FOR AFRL/RZOF (SF)

FROM:

SUBJECT: Visitor’s Pre-Announcement Notification

1. The below listed individual assigned to _________________________________________ will require access to the Air Force Research Laboratory (AFRL), Edwards AFB CA for the purpose specified below:

a. NAME: _________________________ _________________________ ______

(LAST) (FIRST (NO NICKNAME)) (M.I.)

b. SSAN: _________________________ CITIZENSHIP: _________________________

c. PLACE OF BIRTH: _________________________

NATURALIZATION CERTIFICATE #: ________________________________

NATURALIZATION CERTIFICATE DATE: ____________________________

NATURALIZATION CERTIFICATE LOCATION: _______________________

d. SECURITY CLEARANCE DATA: ______________________________________ (Type/Investigation Data/Conduct By)

e. LEVEL OF DISCUSSION: Classified: ____ Unclassified: ____ Public Domain: ____

f. DURATION OF VISIT: Beginning: _________________ Ending: _________________

g. AFRL POINT OF CONTACT (POC): _______________________________________

h. ORGANIZATION/OFFICE SYMBOL: _______________________________________

i. AFRL POC’s TELEPHONE NUMBER: _______________________________________

j. SPECIFIC PURPOSE OF VISIT(s): _______________________________________

k. LOCATION OF VISIT (BLDG #/AREA): ______________________________________

l. WILL ACCESS BE REQUIRED FOR ZONE 2: YES _____ NO _____

SIGNATURE OF UNIT/COMPANY/FIRM SIGNATURE OF AFRL CONTACT

SPONSOR/SECURITY MANAGER/OFFICER (Gov’t Program Manager)