SUBJECT: WELCOME CENTER Base Entry Access Request

MEMORANDUM FOR 633d SFS/S5P

Effective Date:

FROM:

SUBJECT: WELCOME CENTER Base Entry Access Request

I request base access for the following individuals in reference to the below function/event. I understand that I will be responsible for all guests under my escort and for whom I will be sponsoring.Please alphabetize names Last name First name Middle initial-if, no Middle initial is in their name, please, place for clarity NMI; do not exclude any portion of the DoB at all. Month/ Day/ Year is the only thing acceptable.

Sponsor’s Information

Name/Rank: / Organization:
Work Phone: / Cell Phone:

Function/Event Information

Type of Event: / Location:
Date: / Time:
Expires:

Point of Contact (POC) Information

POC Name:
POC WP: / POC HP: / POC CP:
Sponsored Person(s) / DATE OF BIRTH(S) / U.S CITIZEN / COUNTRY OF
CITIZENZHIP / PASSPORT
NUMBER
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N
Y / N

********************************************************************************************************************

I fully understand I MUST limit my guest(s) movement to authorized traffic ways only, and I MUST ensure all parties stay away from any area posted as a Restricted Area or Controlled Area, and by accepting this authorization, all guests entering the base give their consent to search their vehicle while it is entering, on, or leaving Langley Air Force Base. If any vehicle is towed or impounded, each party must know they must reimburse the towing agent on behalf of the vehicle owner/operator. Additionally, all guests have been briefed to have photo identification ready to show the gate guard.

Printed Name of Sponsor:

Hand Signature of Sponsor:

Authenticated By: ______/633 SFS/S5P

VETTED BY : ______633 SFS/S3T (S5P)

PRIVACY ACT STATEMENT

AUTHORITY: Title 50, U.S. Code, Chapter 23, DoD 5200.08P Paragraph 3.2, DoD 5200.08-R Paragraph C3.3.1.4, AFI 31-601, Chapter 7, AFTTP 3-31.1, Paragraph 2.4.4.

PRINCIPLE PURPOSE: Screen potential visitors for unescorted access to Langley AFB with a local agency check to determine outstanding warrants, hostile or terrorist affiliation. Sponsor's information is required to verify employment on Joint Base Langley-Eustis and authorization to sponsor visitors.

ROUTINE USE: Used by Security Forces for the screening and entry control for the duration of the visit. Information will be loaded into the Security Forces Information Management System (SFMIS) shared by Air Force security units worldwide and electronic information is destroyed in accordance with Air Force Records Information Management System (AFRIMS).

Send or email to

Call 757-764-1687 for any questions

DISCLOSURE: Voluntary, however, failure to finish the information requested will result in denial of entry