Base_Access_Request.docx
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- Attached to
- Replace Bay Exhaust System Bldg. 859
- Solicitation number
- W912JB19Q5028
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Selfridge Base Access Request
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SELFRIDGE AIR NATIONAL GUARD BASE ACCESS FORM
Pre-registration is MANDTORY for access to the base. Email Access Form (with a copy of drivers license).
Email to: daniel.t.taliaferro.mil@mail.mil
Add to the Subject Line: W912JB-19-Q-5028 Replace Bay Exhaust System Bldg. 859
Must be turned in NLT 1600 on 17 June 2019
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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