DEPARTMENT OF THE ARMY 807TH MEDICAL COMMAND (DEPLOYMENT SUPPORT) 106 SOLDIERS CIRCLE FORT DOUGLAS, UTAH 84113-5007
807TH MCDS LIK Program Lodging Request Form ******************************************************************* LIK requests are due no later than 30 days prior to the Drill requested. Request For Lodging: _
__ Check In
Check Out
# of Nights
L. Name: F. Name: Rank:
M Initial: Last 4 SSN:
UIC: Phone Number Primary: Email: (MIL)
DOD ID#:
PL:
SEC: Secondary: .mil@mail.mil (CIV)
I hereby request to participate in the 807th MCDS LIK Program. I have completed and signed the Statement of Understanding. I fully understand and agree to the conditions outlined in the 807th 37-1 Chapter 8 and the Statement of Understanding.
I understand that it is my responsibility to ensure that a reservation is cancelled in writing to the LIK Coordinator if I do not plan to use LIK lodging NLT 48 hours prior to the reservation date. Failure to cancel the reservation will result in 6 month loss of use of the program. A second failure to cancel a reservation within a 12 month period after reinstatement will result in forfeit of this program. Only the MCDS commander can reinstate the program for a Soldier once it has been forfeited.
I understand that I will be held liable and agree to collection from my military pay for the cost of lodging if I fail to honor my reservation and incur a liability to the government from a lack of timely notification to the UPC and GPC Cardholder.
Signature of Soldier: Date:
Commander’s Signature: Date:
LIK Monthly request 07 APR 2017