Base_Access.docx

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Corrosion Control July 2019
Solicitation number
W912JB19Q5025
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Base Access

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SELFRIDGE AIR NATIONAL GUARD BASE ACCESS FORM

Pre-registration is MANDTORY for access to the base. Please email the word version Base Access Form to allow for copy and paste.

Email to TAMI.L.MCKENNEY.CIV@MAIL.MIL

Add to the Subject Line: W912JB-19-Q-5025 Corrosion Control

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:

29000 George Ave, Building 139, Selfridge ANGB, Michigan, 48045

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:

29000 George Ave, Building 139, Selfridge ANGB, Michigan, 48045

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