Industry_Day_Registration_Form.docx

JCREW I1B1 FRP INDUSTRY DAY REGISTRATION FORM Page 1 of 3 Joint Counter Radio-Controlled Improvised Explosive Device Electronic Warfare (JCREW) Increment 1 Block 1 (I1B1) Full Rate Production (FRP) Industry Day Registration

Please e-mail this completed registration form to the attention of Jordan Pitt at jordan.pitt@alcyoneinc.net. There is a limit of five (5) persons per company. Pre-registration is required and must be received no later than Friday, April 8, 2016 by 4:00 p.m. Eastern Daylight Savings Time (EDT). ONLY U.S. CITIZENS are permitted, and all attendees MUST provide a valid photo ID on the day of the Industry Day. All attendees must also submit visit requests to the MITRE Corporation through the Joint Personnel Adjudication System (JPAS) or by FAX as specified in The MITRE Corporation Incoming Visit Requests Passing Instructions.

Unregistered visitors will not be permitted to attend Industry Day.

Check boxes below to request documentation:

Statement of Work (SOW)

Request Technical Data Package (TDP)

Request P-SPEC (Requires SECRET clearance)

Name

Citizenship

Company Representing

Company Address and CAGE Code

Telephone Number

E-mail Address

Position/Title

Name

Citizenship

Company Representing

Company Address and CAGE Code

Telephone Number

E-mail Address

Position/Title

Name

Citizenship

Company Representing

Company Address and CAGE Code

Telephone Number

E-mail Address

Position/Title

Name

Citizenship

Company Representing

Company Address and CAGE Code

Telephone Number

E-mail Address

Position/Title

Name

Citizenship

Company Representing

Company Address and CAGE Code

Telephone Number

E-mail Address

Position/Title

If requesting classified material, provide the following:

Classified Mailing POC (Name and Title)

Classified Mailing Address

Security Manager (Name, Phone Number and Email Address)

CAGE Code

Requested Method of Delivery (Please select ONE)

Name:

Phone:

Email:

Anyone receiving classified material must comply with all classified designation, marking, protection, handling, destruction, transmission, transportation and storage requirements as identified in Department of Defense Manual 5200.01, Volume 3 series.