Base_Access_18Q5039.docx

DOCX document 12 KB Posted Aug 18, 2018

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Base Access Form

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Attachment 1

SELFRIDGE AIR NATIONAL GUARD BASE ACCESS FORM

Pre-registration is MANDTORY for access to the base. Email Access Form.

Email to katherine.a.sutton.civ@mail.mil

Add to the Subject Line: W912JB-18-Q-5033 Airfield Insecticide

Authorized Visitor Information complete for each person who will be attending:

Full Name: Last, First, Middle: __________________________________________

JR/SR: _______________________________________________________________

Date of Birth:__________________________________________________________

Driver’s License (State of issue and number)_________________________________

Gender and Race_______________________________________________________

Country of Citizenship/Passport Number____________________________________

Destination on base: 127 MSC Contracting Division, Bldg 105