OWL Radio

FORM B

Contact Person Information

q Be aware that you will be responsible for alternate power sources, such as a generator if the need arises.

Ø I,____________________________ am aware of this requirement.

SIGN_________________________________ DATE_____________________

Contact Person or Responsible Party From Organization:

Ø ______________________________________________________

Ø Phone:( )____________________

Ø Full Address:___________________________________________

Ø City/State:______________________ Zip:____________

Ø Email:__________________________

Ø Social Security Number:_______-_______-_______

Ø Driver’s License Number:____________________

MANAGEMENT ONLY

q This information is fully complete.

MANAGER:___________________________________

SIGNATURE:__________________________________