Atch 1 - NSSL Ph3 Industry Day Participant Request Form.pdf


Original Source
Contract Opportunity
Feb. 16, 2023



NSSL Industry Day Participant Request Form

Date and Time:
28 February 2023:

- General Session: 0800-1200 PDT
- One-on-One Sessions: 1300-1600 PDT

1 March 2023: One-on-One Sessions (if necessary)

Space Systems Command
Gordon Conference Center (GCC)
483 North Aviation Blvd
El Segundo, CA, 90245


Company POC:

Identify In Person Participants for Industry Day (Maximum of 5):

Full Name: Last, First, Middle Date of Birth

Drivers License / State

Last 4 SSN

(Please note any non-U.S. Citizens will not be allowed to attend this Industry Day)

Please adhere to the example below when entering In Person Participant information:

NOTE: We cannot accept drivers license or state IDs that indicate FEDERAL LIMITS APPLY
per REAL ID ACT of 2005. A person in possession of such document must have another form of
picture identification such as a US passport. People listed MUST be US Citizens.

Last Name, First Name, Middle Name: SCOTT, TYLER ROBERT (NOT BOB)

Date of Birth: MONTH/DAY/YEAR (Ex: 06/28/1978)

Drivers License Number and State: All Numbers, Letters and State of Issuance must be

included (Ex: X01234567 CA).

Last 4 of Social Security Number (SSN): Mandatory for All In Person Participants

Potential Phase 3 Launch Service Providers One-on-One Session:

The Government considers a potential Phase 3 Launch Service Provider to be any space access company
with an existing and/or planned launch system capable of lifting a NSSL-class payload to orbit.

Check box if requesting a One-on-One discussion after the general session?

Additional Comments:

Please fill out and return this form to Mr. Greg Pierson at and
Capt Foster Davis at no later than 1300 PDT on 21 February 2023.