Form to Visit the HRIBF

This document and your data are encrypted because we require your U. S. social security number (if you have one) and/or your passport number. Please ensure that your browser is indeed using encryption before you proceed! If you prefer to communicate sensitive data in some other manner, just leave the particular data field blank and we will contact you. Be aware, however, that this does slow down your application for a visit.
Please provide the following information. As we need to submit each experimenter's application to ORNL, we request that you register as soon as your travel plans are known. Unless other arrangements are made, you will only have access to the Building 6000 area.
Visits are less than seven days per year and do not involve "hands-on work" such as conferences, tours, and consultations.
Assignments are longer than seven days per year or involve "hands-on work" such as data analysis and laboratory work, or you expect to be paid or reimbursed for services.
Experimenters coming to participate in an experiment should use a different form.

Time it takes to process your request to come to ORNL.
Citizenship Visits Assignments
U.S.A. 2 days 2 weeks
Non-sensitive countries 2 weeks 3 weeks
2 weeks 8 weeks

Please select the type of visit according to the definitions above.

Short visit

ORNL Contact Person
Arrival Date at ORNL (MM:DD:YY)
Departure Date from ORNL (MM:DD:YY)

Please provide the following information about yourself.

Last (Family) Name
First name (as given in passport)
ALL other names (as given in passport)
Position Title
Street Address
Postal Code
E-mail Address (Internet)

As a consequence of the strong magnetic and rf fields present at the HRIBF, there are some potential health hazards associated with visiting Building 6000 where the accelerators are housed. If you wear a pacemaker for your heart, please inform us prior to your visit.

Please supply this additional information about yourself.

U. S. Social Security Number (please write NA if you don not have one)
Date of Birth (MM:DD:YY)
City and Country of Birth
Highest University Degree and Subject
Date of Degree
University Granting Degree

If you are not a U. S. citizen, you must also supply this additional information about yourself. You must also fax us a copy of the page in your passport which contains your name, place of birth, etc. Our fax number is +1-865-574-1268.

Passport Number
Passport Expiration Date
Visa Type
Visa Expiration Date
U.S. Port of Entry
Date of Entry to U.S. (MM:DD:YY)

Please review all the information above and, if correct, submit the form.

HRIBF Accelerators RIB Injector RIB Development Research Experiments Users Group Staff ISOL'01 Conference
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