Site_Visit_RegistrationForm_rucker_refuse_collection.docx

Registration Form Fort Rucker Refuse Collection sOLICITATION W9124G-16-B-0004 Site Visit

Event Location: Fort Rucker, AL Date/Time: May 31, 2017, 09:30 - 1500 No more than two (2) representatives per company are allowed to attend the pre-brief and site visit tour. All attendees must be pre-registered. The Government reserves the right to deny admittance to any representatives who are not pre-registered or exceed the limitation of participants.

Contractors will have to register at the main Fort Rucker gates (Daleville or Ozark gate) and obtained a "visitors" pass to gain access to Fort Rucker (driver's license and PROOF OF VEHICLE INSURANCE IS REQUIRED).

A signed copy of this registration form must be received from each company representative that plan to attend the site visit.

COMPANY NAME: _______________________________________

ADDRESS: _ _____________________________________________

CITY: ________ ___ STATE: ____________ ZIP: _______

PHONE NUMBER:________________

REPRESENTATIVE’S NAME: _____________________________

EMAIL:_______________________________________________

SIGNATURE: ______________________________________

NUMBER ATTENDING: ___________

BUSINESS SIZE: ______________________________________

CAGE CODE________ DUNS______________

TIN______________

Please submit your completed registration form via email NO LATER THAN 4:00 p.m. EST, Thursday May 25, 2017 to Areatha Thomas, Contract Specialist, email: areatha.m.thomas.civ@mail.mil.