VISIT REQUEST FOR CLASSIFIED SESSION - The Institute of ...



VISIT REQUEST FOR JNC 2015 JOINT NAVIGATION CONFERENCECheck all boxes that apply. VISIT REQUEST: FOR OFFICIAL USE ONLY SESSIONSU.S. Citizens ONLY2015 Joint Navigation ConferenceJune 22-24, 2015 VISIT REQUEST: CLASSIFIED SESSIONSU.S. Citizens ONLY 2015 Joint Navigation ConferenceJune 25, 2015INSTRUCTIONSTo process this visit request, the following information must be provided:“FROM” field: The company's name, full address and Cage CodeVisitor(s): Name, Date of Birth, Place of Birth, Citizenship, Clearance Level and Date Clearance was grantedThe visit request should be faxed to Diane Jacobson at (505) 853-6677. This form is due no later than May 18, 2015. Photo ID and ION Registration Badge will be required for entry into sessions. TO (Name and Address):Diane JacobsonPhone: 505-853-6360Joint Navigation Warfare CenterFax:505-853-6677Diane.jacobson.ctr@us.af.milFrom (Company's name, Full Address and Cage Code):1. Visit approval is requested for the following JNC attendees: NameDate of BirthPlace of BirthCitizenshipClearance LevelDate Clearance was Granted2. Name and Location of Activity:JNC 2015 FOUO Sessions (June 22-24)JNC 2015 Classified Sessions (June 25)Renaissance Orlando at SeaWorldShades of Green on Walt Disney World Resort6677 Sea Harbor Dr.1950 Magnolia Palm Dr.Orlando, FL 32821 Lake Buena Vista, FL 328303. Date of Visit:FOUO: June 22-24, 2015Classified: June 25, 20154. Purpose and justification of Visit (brief explanation of how attendance is related to your position or program):I hereby certify that attendance is necessary in the interest of US national defense and that the attendee has a need-to-know of work being performed under, or in connection with, US Government or User Agency Program.5. Name and Title of Authorizing Official6. Signature of Authorizing Official7. Phone8. Fax9. DateAuthorizing Officials are Industry FSO’s, USG/Military Supervisor or USG Contracting Officials.For FOUO only, a company Human Resources representative may verify your I-9 Form and complete the visit request. ................
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