Duration of Visit:                 Arrive   Depart

        dd/mm/yyyy                                  dd/mm/yyyy

  Name:                (Select One) Mr. Ms. Mrs. PVT PFC SPC CPL SGT SSG SFC MSG 1SG SGM CSM LT CPT MAJ LTC COL BG MG LTG GEN  Last  First  MI

  Purpose  of Visit:

            Name of Event/Course/Conf…

            Your Affiliation (Who do you Represent): (select one) CAARNG ARNG ANG USAR AC Army USN USMC USAF Other DOD Fed Gvm't State/Local Gvm't Contractor Youth Program Civilian (Self)

            CSLO Organization/POC (Who are you here to see):

Phone:

  VEHICLE INFORMATION:

  Make  Model  Year  

  Lic. Plate No.   VIN No.  Reg Exp Date    

  Insurance Information:

            Company   Policy No.  

            Policy Expiration Date

WARNING

THIS INSTALLATION IS PROPERTY OF

THE STATE OF CALIFORNIA MILITARY DEPARTMENT.

 ENTRY TO THIS INSTALLATION CONSTITUTES THE RIGHT OF SEARCH AND SIEZURE BY MILITARY PERSONNEL. ANY QUESTIONS IN THIS REGARD MAY BE DIRECTED TO THE CSLO OPERATIONS OFFICER AT (805) 594-6546.