Required Badging Information for Foreign Nationals (non-US Citizens):

Please send the following information by email to randall.e.bailey@nasa.gov or telephone at (757) 864-8682 as soon as possible –

Last Name:

First Name:

Middle Name:

Gender:

Currently living in US (Y/N)?

Date of Birth:

Birth City:

Birth Country:

Email Address:

Phone Number:

Business:

Business/Company Name:

Position / Title:

Business/Company Address (Street/City/State/Country):

Citizenship & Credentials:

Citizenship Country:

Dual Citizenship country (if applicable):

Are you a lawful permanent resident (Y/N)?; and if so, Greencard No. and Expiration Date:

Passport No.:

Passport Expiration Date:

Passport Country:

Residential Info:

Residential (Home) Address:

City:

State:

Country:

Zip (postal) code: