Ph:8015752423|Fax:8015752377|P.O.Box145550,SaltLakeCity,Utah84114|slcairport.com/badging|airportaccesscontrol@slcgov.com
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OVERVIEW
This form must be completedand submittedtotheBadging Officeimmediately upon change of badge status (lost, stolen, terminated,
resignation,oradministrativedeactivation).Thebadgemustbe returnedto theBadgingOfficewithin 24hoursof deactivation(unless
lost/stolen).Inadditiontothe$100feeassessedfora
nonreturnedbadge,companiesarealsosubjecttoa$100feeforfailuretonotify
theAirportofabadgestatuschange.
Completetheforminitsentiretyandeitherfaxto(801)5752377oremaildirectlytotheBadgingOfficebyselectingtheClicktoSubmit
buttonbelowaftercompletingoftheform.
SECTION1
BADGETOBEDEACTIVATED
LastName
FirstName
BadgeNumber
CardNumber
CompanyName
Isthebadgeinpossessionofyourcompany?YesNo
SECTION2
INDIVIDUALREQUESTINGDEACTIVATION
Individualmustbeanauthorizedsigner.
LastName
FirstName
PhoneNumber
CompanyName
EmailAddress
SECTION3
REASONFORDEACTIVATION
EmploymentTerminatedLostStolenAdministrativeDeactivation(IndicateReasonBelow)
AdministrativeDeactivationDetails
SuspensionMilitaryExtendedMedicalLeave

Other_______________________________________________________________________________________________
CLICKTOSUBMIT
SECTION4
ACCESSCONTROLUSEONLY
DeactivatedBy/Date
Comments
July2015
SALTLAKECITYDEPARTMENTOFAIRPORTS
REQUESTFORBADGEDEACTIVATION
Badge#
PersonID#
Submit Request
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