SPACE A SIGN-UP

PRIVACY ACT STATEMENT AUTHORITY 10 U.S.C. B013; EO 8397, 22 November 1943.
PRINCIPAL PURPOSE:
To apply for air travel, SSN is needed for positive ID.
ROUTINE USE(s): Records from this system of records may be disclosed for any of the blanket routine uses published by the air force.
DISCLOSURE IS VOLUNTARY: Failure to provide the information may result in member not being accepted for travel on military aircraft. Disclosure of SSN is voluntary.
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"THE INTERNET IS NOT SECURE! PLEASE DO NOT PASS ANY INFORMATION THAT YOU DO NOT WISH KNOWN. IF YOU DO SO, YOU ACCEPT LIABILITY FOR DISCLOSURE OF SAID INFORMATION."
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1. Copy and paste all of the following information into an E-Mail.
2. Provide requested information for each line.
3. Send the E-Mail to: 78lrs.paxterm@us.af.mil
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If there are problems, someone may need to contact you for more information, please provide the following non-essential data for this purpose.

Email Address:

Home Phone:

Duty Phone:
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The following is MANDATORY! If not completed, your application WILL be disregarded.

Name (Last, First, Mi):

Rank:

SSN (optional):

Seats required:

Travel status:
_____Category I Civ or Mil Dependent on Emergency Leave
_____Category II Environmental Morale Leave (EML)
_____Category III Active Duty on Ordinary Leave / House Hunting
_____Category IV (EML) Unaccompanied Dependents
_____Category V Permissive TDY or TAD / Student Travel
_____Category VI Retired Military / Reserves

For overseas travel: Border clearance documents current? _____YES _____NO

Service: _____AF _____ARMY _____MARINES _____NAVY _____OTHER
Date Leave begins (Active Duty only):

Date leave ends (AD only) (If extended, you must notify us before this date):

Country choices (list up to 5 separated by comma; one choice may be all):

List names of dependents traveling and type of passports (US or Foreign):

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I certify that I am on leave or pass status at the time I register for space available travel and will remain in such status when awaiting and/or have been accepted for space available travel. If accompanied by dependents, I further certify that my travel is not in conjunction with TDY/TAD and that I am not using space available travel to transport my dependents to or from my restricted duty station or all others (unaccompanied) tour location station. I certify that my request for, and acceptance of, transportation via DOD-owned or controlled aircraft is not for personal gain, nor for, or in connection with business of any nature and that this trip will not result in any form of remuneration to myself of my family. I understand violation of any of the above could result in billing and/or punitive action.

Date:

Signature (First and Last Initial and today's date YYYYMMDD): 


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