Visitor Request Form - UMD Radiation Facilities
Dear Visitor,
Prior to your upcoming visit to the University of Maryland's Radiation Facilities we require some basic information to ensure everyone's safety and security. Please fill in this form prior to your visit. Remember to bring a form of picture identification to your scheduled tour.

Please be aware that we do not allow cameras, cell phones or bags into our facility and that we do not have a secure location to store these items.

Note: If you are not affiliated with the University of Maryland, please fill out this (https://goo.gl/CwK62L) form instead and return to Timothy Koeth at koeth@umd.edu or Rm. 2303 Building 090 University of Maryland, College Park, MD 20742. Forms must be received a minimum 48 hours before planned visit. A completed form is in no way a guarantee that admittance will be granted.

Name (First, Middle, Last) *
Your answer
Email *
Your answer
Date of Birth (MM/DD/YYYY) *
Your answer
Country of Citizenship *
Your answer
UID *
Your answer
Date of Visit *
MM
/
DD
/
YYYY
Reason for Visit *
Your answer
Signature *
Your answer
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