MILL CREEK PIER SLIP APPLICATION Marina Use Only:
Application #: _____
PRIVACY ACT INFORMATION
Authority: 5 USC 301, 44 USC 3101
Purpose: To obtain information on MWR patrons who apply for a slip at Mill Creek Pier, Naval Station Annapolis.
Usage: To maintain records by which slip applicants may be contacted for slip lottery or to effect payment of charges due.
Disclosure: Disclosure is voluntary; however, failure to do so may result in loss of privileges to sign a contract for a slip.
Last First Middle
Home Phone: (____)_____________ Work Phone: (____)__________ Mobile (____)___________
E-mail Address: ______________________________________________________
STATUS: (Please check only one status) RANK / GRADE: _______________________
o 1. Active Duty Personnel
o 2. Delayed Entry Personnel / Midshipmen
o 3. Members of Reserve Components (Ready Reserve & National Guard on active duty / Reservists in Training)
o 4. Armed Forces Retirees
o 5. Former and / or surviving spouses and family members
o 6. DoD Civilian employees (APF and NAF) assigned to the USNA Complex
o 7. DoD Contractor working on the USNA Complex
o 8. Space “A” for authorized personnel not assigned to the USNA Complex
Boat Details: Length _________________ Beam _________________ Draft _________________
I understand that in the event my application is granted use of a slip at Mill Creek Pier, I am prepared to sign a contract and will abide by the terms and conditions set forth by Carr Creek Marina. Failure on my part to do either requirement, will result in denial of this application. All contracts will expire on 30 Sep.
Applicant’s Signature: ________________________________________________________________
Date of Application: ___________________________________________
Month Day Year
For Carr Creek Marina: ________________________________________________________________
NAVSUPPACT Annapolis KTN 1710/43 (4-13)