EFTA01650146.pdf

Federal Bureau of Investigation Victim Services Division Epstein Briefing RSVP NY October 15, 2019 - Miami, FL I I October 23, 2019 - New York, emailbox by October 4, Please fill out the following form and return to the 2019. Full Name: Click here to enter full name Email Address: ( address Phone Nu ere to en er phone number Social Security Number: Click here to enter SSN Address 1: Click here to enter address 1 Address 2: Click here to enter address 2 Zip: Click here to enter zip h: City: Click here to enter city State: Click here to enter state mm/dd/yyy y Citizenship: Click here to enter citizenship Country of Birth: Click here to enter countr of birth ciHzen If you have spoken with a FBI Victim Specialist, please provide their name: Click here to enter VS name NO Can you attend? riYes, I will attend (:) No, I cannot attend If yes, which location will you attend? u 1O/15/2O19 Miami, Fl 1O/23/2O19 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 r i No, I will not bring a support person PhOOMP Will you need travel arrangements? Yes, I will need travel arrangements f/NO, I will not need travel arrangements If yes, which mode of transportation do you prefer? Air o Rail V‘,15 0 Mileage reimbursement (if you are utilizing your 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. Airport of origin: Click here to enter departure airport name Preferred time of travel: Click here to enter preferred time of ,r - Do you require lodging? EFTA01650146