MERRILL Guest Request Form – GUEST PORTION As a valued MERRILL guest it is imperative that you complete the remainder of this form in its entirety. Upon completion simply click SUBMIT. Enjoy your visit! Please note, you must present a U.S. Government and/or State-issued photo ID upon check-in. Guest First Name* Guest Last Name* Guest Phone* Guest Email* Date(s) of Visit* Entrance Badge Location (where you will initially meet)* (Visiting? Y/N) 400 Florence St. Saginaw, MI 48602* (Visiting? Y/N) 1023 S Wheeler St, Saginaw, MI 48602* (Visiting? Y/N) 21659 W. Gratiot Rd., Merrill, MI 48637* (Visiting? Y/N) 520 Republic Ave., Alma, MI 48801* (Visiting? Y/N) 2000 S. Hamilton St., Saginaw, MI 48602* (Visiting? Y/N) 1375 S. 25th St., Saginaw, MI , 48601* Host First Name* Host Last Name* Host Email* I am a (Choose only ONE):* U.S. Citizen (Via birthright or naturalization) Permanent U.S. Resident (Green Card Holder) Non-U.S. Person (Anyone who is not a U.S. citizen, a lawful permanent resident or protected individual) U.S. citizen who represents a foreign government U.S. citizen who represents a foreign company U.S. citizen who represents a foreign organization that is not incorporated in the U.S. U.S. citizen who represents an international organization (NATO, UN, etc.) I am a Returning Visitor* Yes No Residential Address* City State / Province / Region Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands I am a U.S. Government Employee:* Yes No Name of Company* Name of Governmental Agency* Driver's License Number* Issuing State* Foreign Persons / Foreign Nationals Only. Original Passport required at Entry:Passport Number* Birth Date* MM slash DD slash YYYY Expiration Date* MM slash DD slash YYYY Issuing Country* Citizenship Country* I Agree to the MERRILL's Group Safety Rules: (See Below)* Yes No Download MERRILL's Group Safety RulesI Agree to the MERRILL's Non-Disclosure Agreement: (See Below)* Yes No Download MERRILL's Non-Disclosure AgreementUpon completing this form, I understand that any device with the ability to take photos and/or videos is prohibited from the shop floor of all MERRILL facilities. These devices are allowed in designated office/meeting space only. Check with your MERRILL host for clarification on usage. This does not apply to U.S. Government employees. Visitor Approval* Today's Date (Information provided is valid one year from today's date* MM slash DD slash YYYY