NAPM-AZ and APICS Phoenix Chapter
APS Palo Verde Nuclear Generating Station
May 13, 2011
Registration Information and
Required Information for Security Screening and Badging
Please complete the information below. Incomplete forms or empty fields can not be accepted.
Full Legal Name:
(First, Middle, and Last)
Social Security Number:
(or Passport Number for Non US Citizens):
Membership Number: NAPM# APICS# Expires:
Date of Birth:
(Home or Business, Include City/State/ZIP)
Do you have any Artificial Joints? No Yes , explain:
Do you have any metal medical No Yes , explain:
Have you had any Nuclear Medical No Yes , explain:
Treatments That Involved the
Ingestion or Injection of Radioactive
Materials in the Last 30 Days?
To complete the registration process for this joint plant tour, please send this form by May 6th at 5:00
Email: NapmArizona@cox.net link:(NapmArizona@cox.net)
Tour spots are limited for each organization and are on a first-come, first-served basis. NAPM or APICS
members are given preference over non-members. You will receive a confirmation relating to your
tour status before the event (accepted or waitlisted).