Base_Access.docx

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Grounds Maintenance
Solicitation number
W912JB19Q5014
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#5 Base Access

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SELFRIDGE AIR NATIONAL GUARD BASE ACCESS FORM

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

Email to tami.L.mckenney.civ@mail.mil

Add to the Subject Line: W912JB-19-Q-5014 Grounds Maintenance

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

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

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