## Epstein Briefing RSVP October 15, 2019 - Miami, FL I I October 23, 2019 - New York, NY
| Please fill out the following form and return to the | | emailbox by October 4, 2019. | |
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| Full Name: | | e:e ;;;
Email Address: | |
| Phone Number: Click here to enter phone nuri,oL; | | Social Security Number: Click here to enter SSN | |
| Address 1: Click here to enter address 1 | | Address 2: li lL% lure to enter address 2 | |
| City: Click here to enter city State: Click here to enter state | | Zip: Click here to enter zip | |
| Citizenship: Click here to enter citizenship | | Country of Birth: lck here to enter country of birth | |
| If you have spoken with a FBI Victim Specialist, please provide their name: Click here to enter VS name | | | |
| Can you attend? | | | |
| — Yes, I will attend | 0 No, I cannot attend | | |
| If yes, which location will you attend? | | | |
| 0 10/15/2019 Miami, Fl | 0 10/23/2019 New York, NY | | |
| | | You are authorized to bring one support person. Will you be bringing a support person with you to the briefing? | |
| yes, I will bring one support person | | J No, I will not bring a support person | |
| Will you need travel arrangements? | | | |
| Yes, I will need travel arrangements | | 0 No, I will not need travel arrangements | |
| If yes, which mode of transportation do you preferi
r | | | |
| Air
Bus | Rail | 0 Mileage reimbursement (if you are utilizing your own vehicle) | |
| charges incurred such as in-flight snacks, Pay-Per-View, Wi-Fi, etc. | | Only economy, roundtrip fares and one checked luggage bag per person will be authorized. You will be responsible for any incidental | |
| Date of Birth (required by airlines): Click here to enter date of birth
Preferred time of travel: Click here to enter preferred time of travel | | Airport of origin:
Click here to enter departure airport name | |
| Do you require lodging? | | | |
| Pay-Per-View, phone charges, etc. | | Only two nights of lodging will be authorized and only hotel room cost and tax will be authorized. You will be required to provide a
credit card for incidental charges upon check in. You will be responsible for any incidental charges incurred such as snacks, mini bar, | |
| — Yes, I will require lodging | No, I will not require lodging | | |
| Do you require airport transportation? | | | |
| Yes, I will require transportation to/from the airport | | | |
No, I will not require transportation to/from the airport
| Support person information | | | |
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| Support Person's Name: | | | |
| Relationship: Friend | Email Address: | | |
| Phone Number:
Social Security Number: | | | |
| Address 1: | Address 2: Click here to enter address 2 | | |
| City: New York State: NY | Zip: 10033 | | |
| Citizenship: US | Country of Birth: USA | | |
| Will your support person need travel arrangements? | | | |
| Yes, my support person will need travel arrangements Z No, my support person will not need travel arrangements | | | |
| If yes, which mode of transportation do they prefer? | | | |
| Air | E Rail | | |
| Bus | E Mileage reimbursement (if they are utilizing their own vehicle) | | |
| Only economy, roundtrip fares and one checked luggage bag per person will be authorized. You will be responsible for any incidental
charges incurred such as in-flight snacks, Pay-Per-View, Wi-Fi, etc. | | | |
| | Date of Birth (required by airlines): Click here to enter date of birth
Airport of origin:
Preferred time of travel: Click here to enter preferred time of travel
Click here to enter departure airport name | | |
| | If bringing a support person, will your support person require separate lodging? | | |
| Pay-Per-View, phone charges, etc. | Only two nights of lodging will be authorized and only hotel room cost and tax will be authorized. You will be required to provide a
credit card for incidental charges upon check in. You will be responsible for any incidental charges incurred such as snacks, mini bar, | | |
| Z No, my support person will not require separate lodging
Yes, my support person will require separate lodging | | | |
| | If bringing a support person, will your support person require airport transportation? | | |
| | Yes, my support person will require transportation to/from the airport | | |
| | Z No, my support person will not require transportation to/from the airport | | |
| Acknowledgement and Signature | | | |
| | | | |
By checking and signing below, I acknowledge I have read and understand that only lodging, lodging taxes, mileage, and commercial transportation expenses (airfare, bus, train, and hotel transportation only) will be authorized as outlined above. I understand that the following will not be included/provided in the authorized expenses: meals, rental vehicle, entertainment, or other incidental charges.
21 Yes, I acknowledge the above statement 10/19/2019