PRINT this form (1 per site visit requested), COMPLETE and RETURN to the Operations Office 45 days prior to visit if lodging is required.

Today's date:	_________________________________
SITE TO BE VISITED:	Barter Island at Kaktovik	Ft. Yukon
YOUR NAME:	_________________________________	SSN:	____________________________
Date Of Birth:	_________________________________	Place Of Birth:	____________________________
SECURITY CLEARANCE:	_________________________________
SUPPORT REQUESTED: (Check all that are needed)	Lodging (requires 45 days notice!) Messing Transportation	Telephone Use Equipment Other (explain) _________________________
DATES OF VISIT:	_________________________________	Airlines:	____________________________
Arrival at site:	_________________________________	Departure from site:	____________________________
PURPOSE FOR VISIT:	___________________________________________________________________________