Naval Base Kitsap Bangor Submarine Tour Thursday, August 20th Catch Seattle to Winslow-Bainbridge Island ferry at 7:55 AM All guests must board Navy bus on ferry arrival at approximately 8:35 AM to proceed to Naval Base Kitsap Bangor Bus Departs Base at 1:45 PM, to catch 2:55 PM ferry back to Seattle Estimated arrival back to Seattle at 3:35 PM To Register: Please fill out this form and return by July 31st with Privacy Act Waiver and Request to Tour Waiver (seattlerotary.org for documents) Join fellow Seattle #4 members for a VIP tour of Naval Base Kitsap Bangor as the guest of fellow member and Commander, Navy Region Northwest, RDML Jeff S. Ruth! Submarine tour, followed by lunch with sailors. Includes a command briefing that highlights the Navy s investment in the Pacific. Member Legal Name: Veteran? Yes No Title: Date of Birth: / /19 ; Last 4 of SS: US Citizen? Yes No Cell Phone: Guests Registration will be open to guests after July 20th. Filling out the following guest information does not guarantee they will be able to participate. They will be placed on a waitlist in the order received and accommodated if space is available. Guest Legal Name: Veteran? Yes No Date of Birth: / /19 ; Last 4 of SS: Title: US Citizen? Yes No Attendees must board the bus in Winslow there is no separate base access. For more information, contact the office at 206-623-0023 or laura@seattlerotary.org
PRIVACY ACT STATEMENT Name: Address: Telephone Number: Today, July, 2015, I acknowledge that I have received the following advisement under the guidelines of the Privacy Act. This statement is provided in compliance with the provisions of the Privacy Act of 1974 (Public Law 93-579) which requires federal agencies to inform individuals who are requested to furnish personal information regarding the information requested below. 1. AUTHORITY: 5 U.S.C. 301; 10 U.S.C. 972, 1201-1221, 2733, 2734-2734b., 2737, 5013, 5031-5036, 5131-5150, 5947, 6148, 7205, 7622-7623; 28 U.S.C. 1346, 2671-2680; 31 U.S.C. 240-243, 3521-3531, 3701-3702, 3717-3718; 37 U.S.C. 802; 38 U.S.C. 105; 42 U.S.C. 2651-2653; 44 U.S.C. 3101; 49 U.S.C. 1901. 2. PRINCIPAL PURPOSES. The information which will be solicited is intended principally and may be used for the following purposes: a. Determination of eligibility to enter a federal military installation. b. Determination of eligibility to embark a U.S. Navy vessel. c. Other determinations, as required, in the course of federal administration. d. Public information releases. 3. VOLUNTARY DISCLOSURE AND CONSEQUENCES OF REFUSING TO DISCLOSE: a. Disclosure is voluntary. However, if you do not provide the requested information, you will not be allowed to enter a federal military installation or embark a U.S. Navy vessel. Date Signature
REQUEST TO TOUR NAVAL BASE KITSAP/STRATEGIC WEAPONS FACILITY PACIFIC Waiver of Claims In consideration for my participation in a tour within the Operational Area of Naval Base Kitsap-Bangor, Washington, which may include its waterfront restricted area, I hereby freely and voluntarily, and intending to be legally bound, accept all risks associated with this tour, and waive any and all rights to any claim, demand or any other action whatsoever (including but not limited to personal injury, wrongful death, property damage/loss and illness), now and in the future, including those attributable to simple negligence, for damages, due to accident or injury, resulting from this tour, for myself, my spouse, my heirs, my executors and administrators, and any other legal representatives of my estate or on my behalf, which I may have against the United States of America, the Department of Defense, the Department of the Navy, their officers, their enlisted personnel, their civilian personnel, and their successors and assignees. Statement of Awareness I attest and verify that I am aware that Naval Base Kitsap-Bangor is a military base and that there are areas within the Operational Area that are considered to be a military-industrial environment, full of inherent hazards. The most prevalent hazards are located in the areas surrounding naval vessels, piers, wharfs and dry docks. In those areas, there are numerous pieces of military-industrial equipment, which could injure people who are not careful around them. Furthermore, since those areas are used for military work, there are occasionally spills of oil or other fluids, which could easily cause people to slip and fall. Additionally, I understand that I will be in an area where the military handles munitions, which, while generally safe, have the potential to explode and severely injure or kill anyone within their explosive arc. Acknowledgement and Signature I have read the information provided above in its entirety. I recognize that the Operational Area of Naval Base Kitsap-Bangor, Washington is inherently dangerous. Having been warned of and knowing of these dangers, I consciously, knowingly and voluntarily accept the risk of injury, death or damage to property associated with my tour. I further certify that I am legally an adult (eighteen (18) years or older), in good health and able to participate in this activity. (Minors must obtain parent/guardian permission.) SIGNATURE/GUARDIAN DATE WITNESS DATE NAME: (Printed or typed) NAME: (Printed or typed) ADDRESS: COMPANY: PHONE: FAX: Name and address of person to contact in case of emergency: Phone: Hm Wk
COMMANDER SUBMARINE GROUP NINE (CSG-9) TOUR INFORMATION AND GENERAL REQUIREMENTS PLEASE NOTE General public and individual tours are not available. Submarine tours are available to eligible groups as operational schedules permit. Eligible groups include, but are not limited to, Department of the Navy sponsored youth groups, Boy Scouts, Girl Scouts, Sea Cadets, school groups, ROTC/JROTC units, naval organizations and civic groups. GENERAL INFORMATION All guests must be U.S. citizens. The minimum age is 11 years old. All guests MUST show proof of citizenship: * This can be a passport, enhanced driver s license (must say enhanced), or birth certificate. Example of an enhanced driver s license: * The name on the birth certificate must match the name on the photo ID card. If the name(s) has changed due to marriage, official name change, etc. then a copy of the official license/paperwork must be presented as well. * A MILITARY ID (Retired or Active) DOES NOT SHOW PROOF OF CITIZENSHIP. All guests must bring a photo ID to be allowed on base: * This can be a government issued or school issued ID. * IDs must be available throughout the entire visit. * ID requirements for children under the age of 18 that don t have a driver s license or school issued ID are waiverable, but the child must have valid proof of U.S. citizen on him/her for the duration of the tour. All guests must fill out and sign the Request to Tour Waiver document prior to arrival. ***Failure to show proof of citizenship will result in not being able to go on the tour*** ***Failure to have ID will result in not being able to attend the submarine tour*** RESTRICTIONS NO RECORDING DEVICES are permitted (cameras / video cameras / audio recorders) NO cell phones with cameras are permitted. NO portable electronic devices of any kind. NO firearms, knives or weapons of any kind are permitted. NO alcohol or flammable substances are permitted.
(Health and medical related electronic devices are allowed) *** Any of the above items will be confiscated and may be destroyed by military police *** * All guests should be able to climb up and down a 30-foot vertical ladder. * All guests should be in good health mentally and physically. Those prone to claustrophobia or panic attacks should not attend submarine tours. ***The CSG9 Tour Guide has authority to deny guests submarine access if it appears to be too dangerous to the guest s health. *** DRESS CODE MILITARY PERSONNEL: Uniform of the day (no skirts or heels) CIVILIANS: All must wear closed toe shoes / flats (no skirts, dresses or heels allowed). Political or offensive clothing is not permitted. * Failure to comply with the dress code will result in the individual not being able to attend the submarine tour. PARKING & PICKUP INFORMATION Parking and pickup for guests will be at the Keyport Undersea Museum parking lot. ***Parking for tours is located at the end of the lot away from the entrance to the Museum. CSG-9 will provide transportation from the museum throughout the tour and return guests to the museum in the afternoon. You will be responsible for your own transportation to and from the museum. TOUR SCHEDULE 1220 - Bus will arrive at the Keyport Undersea Museum parking lot to meet and greet guests, hand out security badges and depart the Delta Pier. 1300 - Arrive Delta Pier for submarine tour. 1430 - Submarine tour complete. Depart for Keyport. 1500 - Arrive Keyport and drop off guests. The following is a sample of the information necessary for security processing of all guests visiting a submarine: LAST NAME FIRST NAME DOB LAST 4 US CITIZEN TITLE Halford Robert 1/1/1995 1234 YES STUDENT Kilmister Ian 10/27/1957 6905 YES VADM USN (RET) Dickenson Bruce 6/10/1970 4411 YES NONE Use the full legal name that will be on the ID card. (i.e. William vice Bill ) NO NICKNAMES *** PLEASE NOTE *** Once we have received your list, changes CANNOT be made. If there are people in your group that are not sure about going, add them to the list to be safe (omissions and no-shows are fine). Maximum capacity is 28 persons (including escorts for school/scout groups) ALL SUBMARINE TOURS ARE SUBJECT TO LAST MINUTE CHANGES & CANCELLATIONS DUE TO SUBMARINE AVAILABILITY