_______________________  Last name (print)

_______________  First name

____  Initial

_________________________ Signature

Date_______ Fermilab I.D.#________ Date joined CDF Collaboration _________

Status: Physicist (staff__or postdoc__) Grad Student__Under Grad__ Engineer__ Tech____
Summer Student ___ Other__

HOME INSTITUTION:_____________________________________________________

e-mail address(s):__________________________

FERMILAB:

Location(s):

Mail Station:

Office Telephone #(s):

Residence Telephone:

Anticipated length of stay at Fermilab for the next 6 months:
Fulltime___ Biweekly___ Other___

The following check list must be completed BEFORE a computer account can be authorized. ************************************************************************************

Check list to be filled out by CDF Department:

	Initials
Name entered in CDF data base	______
GERT, Rad Worker I or II completed	______
CDF Evacuation Plan/Procedures for fires and tornadoes reviewed	______

________________________________   Signature

__________ Date

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