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Day Use Pass and Navigation Chart Order Form

About Day Use Passes - About Navigation Charts

Privacy Act Statement - "Day Use Pass & Navigation Chart Order Form". The following information is provided to comply with the Privacy Act (PL 93-579). The information is requested pursuant to ER 1130-2-550, Chapter 9 - Recreational Use Fees, as well as 36 CFR § 327 ("Title 36"). This form is used to process requests for Annual Day Use Passes and navigation chart purchases in the Tulsa District, U.S. Army Corps of Engineers. Information is only for the purpose of processing the requested pass or navigation chart purchase. The information is available only to Corps of Engineers employees and is not used for any other purpose. Applicant disclosure of information is voluntary. However, failure to provide information will prevent the processing of Annual Day Use passes.

Day Use Passes are available to U.S. Citizens only.
Passes with Golden Age and Golden Access Passport discounts cannot be sold through the mail.
Print and mail this form.
  Date: _________________________
 Name:  ___________________________________________________________________________________
Address:  ___________________________________________________________________________________
City, State Zip:  ___________________________________________________ Phone: _________________________

What Do You Want To Purchase? - Print the number of items you desire and fill in amount due.
Item How Many Cost Per Item Mailed Due
Annual Day Use Pass   $30.00  
McClellan-Kerr Arkansas River Navigation Chart   $17.00  
TOTAL  $


Payment - Include driver's license number. Make check payable to "FAO, USAED, Tulsa"
Check Only Amount Check Number Driver's License Number
$    

Do not send cash. Make checks or money order payable to: "FAO, USAED, Tulsa" and mail to:
Tulsa District, Corps of Engineers
Attn: Welcome Center
 1645 S. 101st E. Ave.
Tulsa, OK 74128-4609
June 8, 2009