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REQUEST AND AUTHORIZATION FOR TRAVEL OF DOD (1) PERSONNEL

(5) ITINERARY:

(5a) DATE:

(5b) CARRIER:

(7) AUTHORIZED DEPENDENTS:

(7a) NAME:

(7b) RELATIONSHIP:

(7c) DOB:

(7d) CITIZENSHIP:

(7e) AMC LINE #:

REMARKS: Authorized two pieces of checked baggage, not to exceed 70 pounds each and one hand-carried not to exceed 19”x12”x13” on AMC aircraft. Authorized piece(s) at pounds each of excess baggage. Rental vehicle is is not authorized. All TDY and subcontractor personnel must report to their administration office the day of arrival on Kwajalein;

POC:

IT IS IMPORTANT THAT YOU CONFIRM YOUR AMC RESERVATIONS WITH THE HONOLULU OFFICE (808-422-6447) THREE DAYS PRIOR TO YOUR DEPARTURE FROM HICKAM AFB. The SOFA [Article VIII] and USAG-KA/RTS Reg. 190-10, Section 3.2.1, PROHIBITS the importation and possession of firearms, ammunition and explosives at USAG-KA/RTS by persons not specifically authorized in writing. Violators of this regulation will face adverse administrative action.

(9) EMERGENCY NOTIFICATION:

(10) FOR TDY VISITORS / SUBCONTRACTORS ONLY:

(11) ON-ISLAND SPONSOR:

I certify the above named individual(s) is/are authorized to travel under these orders and that authorization to enter Kwajalein has been received from the Commander, U.S. Army Garrison Kwajalein Atoll.

(12) ENTRY/EXIT:

(13) PROVOST MARSHAL OFFICE:

USAG-KA FORM 55-R (Rev.20150506)

(3) TRAVELER:

9.0.0.2.20120627.2.874785

TextField1: HNL
TextField1: KWA
TextField1: HNL
TextField1: KWA
TextField1: Pre-Proposal Site visit for BAAF Runway Repair - Kwajalein Atoll
TextField1: W9128A-19-R-0009
TextField1: Kimberly Warner
TextField1: Resident Engineer
TextField1: Kimberly.M.Warner@usace.army.mil
DropDownList1: Select Traveler Type...
DropDownList4: GS12
DropDownList5: United States of America
DateTimeField1: 2019-04-15
DateTimeField1: 2019-04-16
DateTimeField1: 2019-04-19
DateTimeField1: 2019-04-19
DropDownList6: United
DropDownList6: United
DropDownList6: United
DropDownList6: United
DropDownList2: COME TO ISLAND
DropDownList2: TDY SITE VISIT
DropDownList7:
DateTimeField2:
TextField5:
TextField7:
TextField6:
TextField8:
TextField4: Kara M. Larson Kara.M.Larson@usace.army.mi
DateTimeField3:
CheckBox1: 0
SignatureField1:
SignatureField2:
DateTimeField4:
DropDownList3: CONTRACTOR

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