NATC_Visitor_Pass.pdf

Visitor Release and Entrance Authority Time In:________________

NEVADA AUTOMOTIVE TEST CENTER

A Division of Hodges Transportation, Inc. Day/Time Out ___________

DATE: ________ __________ _________

(DAY) (MONTH) (YEAR)

Print - NAME: ___________________________________________ TITLE: _________________

US Citizen? Yes/No _____________________ Security Clearance: __________________________ Country Company ________________________________________________________________________

Division/Program Group/Office__________________________________________________________

Business Address: _________________________________________________________________

Business Phone: ___________________________ Cell Phone: ___________________________

E-Mail Address: __________________________________________________________________

Resident Address: _________________________________________________________________

Purpose of Visit: _______________________ Contact: ___________________________________

I Carry: Camera/Video Equipment ____________ Briefcase _________ Package ______________

Cell Phone_____ Laptop Computer ________________ MIS Authorization __________________

NOTICE: No computers may be connected to the HTI network without written authorization. On-site modem use is at the discretion of your HTI contact. Unauthorized network access can result in the confiscation of your computer.

HTI Authorization: Camera (OK) ___________________ (STORED) _______________________ Exec Signature Office Signature

NOTICE: No cameras can be carried or used by this visitor during his/her visit without the written authorization of Corporate Officer. Any camera/video equipment may be left at owners risk at the Visitor’s Desk. Unauthorized photographs, film or videotapes may be confiscated by the Company.

VISITOR RELEASE

In consideration for the permission granted to me by Nevada Automotive Test Center, a Division of Hodges Transportation, Inc. to enter upon its premises, observe its test procedures or participate therein, I do hereby release and hold harmless said Hodges Transportation, Inc. and its officers, agents and employees from liability or claim of liability arising by reason of any injury to my person or property occurring while I am on premises owned, or controlled by said Corporation or in or about any vehicle owned, leased or operated by said Corporation or any of its officer, agents or employees. Also in Consideration of such permission, the undersigned agrees not to disclose to others, nor to use any information disclosed to him/her by the Corporation, or derived by him/her during his/her visit, except for any part of such information that is available publicly or from other lawful sources.

Visitor Signature ______________________________________________

HTI Escort to fill in Below

Authorized length of visit From: _____________ to ______________ Badge Issued ______________

Authorized by: ___________________________________________ Badge Returned ____________ This pass authorizes this visitor to enter the facility for this visit only. Visitor must be accompanied by HTI Escort at all times. Badge must be returned or renewed before expiration date above.