807th MCDS LIK Program Lodging Request Form

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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


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