Direct Notification Registration Form

U.S. ARMY FORT ORD BASE REALIGNMENT AND CLOSURE OFFICE
2012 PRESCRIBED BURN PROGRAM
DIRECT NOTIFICATION REGISTRATION FORM


Complete this form to receive direct notification 
(a phone call, text, and/or e-mail message) that prescribed 
burn could occur shortly (within a day or two), when the 
prescribed burn is started, and again when the burn is complete. 
The Army will not share your personal contact information. 
Providing your address is optional; however, if your address is 
provided, the Army will mail information about the 2013 
Prescribed Burn Direct Notification Program.

(Please print clearly)

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Date: ____________________________

Name: ____________________________

Mailing Address: ____________________________

________________________________________________________

____________________________
(include street address or PO Box, City, State and Zipcode)


Phone Number:____________________________
( ) Voicemail
( ) Text
( ) Voicemail and Text

Alternate Phone Number:____________________________
( ) Voicemail
( ) Text
( ) Voicemail and Text

(If you wish to be notified by phone there must be an 
answering machine or voice mail on the phone or someone must be 
available to receive the message. Do not provide phone numbers 
that include an extension, or that connect to a voice menu system.)

Email Address: ____________________________

Alternate Email Address: ____________________________


   Fill out this form and mail or fax to:

	Base Realignment and Closure Field Office
	Fort Ord Prescribed Burn Direct Notification Program
	P.O. Box 5008
	Monterey, CA  93944-5008


    Fax: (831)393-9188

Call (831)393-1284 or toll free at 1-800-852-9699 if you
have any questions, or go to http://www.fortordcleanup.com
E-mail: Melissa.Broadston@us.army.mil
Call 242-7383 or toll free at 1-800-852-9699 if you have any questions, or 
check the web site at www.fortordcleanup.com for up-to-date information. 
Para obtener una copia en Espanol contacte (831) 393-1284