ABCDEFGHIJKLMNOPQRSTUVWXYZ
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Georgia Army National Guard
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TRANSPORTATION AGREEMENT
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DATE OF MISSIONAIRCRAFT/VEHICLE
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3-Jun-24CH-47 or UH-60
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Place/LocationFULL NAME OF PASSENGER
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HAAF JCLC
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LAST 4 SS:
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PERMANENT ADDRESS
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For and in consideration of being permitted to travel as a passenger in aircraft and or other types of vehicles and modes of transportation operated by or on behalf of the United States of America, or the Georgia Department of Defense, or both, for and on behalf of myself, my personal representatives, heirs and assigns, I hereby release and discharge and agree to indemnify and hold harmless the United States, the State of Georgia, and the Georgia Department of Defense, their officers, agents, servants and employees from any and all claims whatsoever for property damage and/or personal injury or death resulting from or during such flight or flights and other modes of transportation.
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ADULT SIGNATURE
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DATE
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Witness/ Guardian Name
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Witness/ Guardian Signature
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NAME AND ADDRESS OF PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
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REV 0702 TAG
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