Rockwell Collins Registration Form
CASE CM PAID SUBSCRIBER
Load form into your browser, fill out electronically, print it, and sign it. Upon completion, scan signed doc. and send .pdf file to Katie Deerberg , 319-263-4296
or Bryon Kanne, 319-295-6772 at case-acct-mgmt@rockwellcollins.com
A copy of this form must be retained at the program level as evidence of Citizenship for audit purposes.

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Applicant Information: To be filled out by applicant

Does this user have an existing Alliance account? Yes   No If "Yes", Provide userid

For IDMGMT Use: UserID

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Legal Name (First M.I. Last)
Phone (Area Code+Number)
Street Address
City, State, ZIP, Country
Company Name
Your Email Address

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Are you a U.S. Citizen?     Yes   No

If "no", do you hold an INS Green Card?     Yes   No

List ALL Countries of Citizenship:  1st 2nd 3rd

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Access Requirements

CS-CASE-PAID-SUBSCRIBER

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Approval Signatures
By signing this form, I agree to: (a) comply with International Traffic in Arms Regulations  (ITAR),Export Administration Regulations (EAR). Failure to comply will result in termination of access privileges and may be subject to fines and penalties under the Arms Export Control Act (22 U.S.C. 2778); (b) comply with applicable Proprietary Information Exchange Agreements (PIEA) or confidentiality provisions of any contracts, and all applicable software licenses; and (c) grant consent and approval to gather and process the personal data requested solely for the purpose of administering access to and ensuring the security of any data and computing applications made available by Rockwell Collins.

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Applicant's Signature and Date (above)		Applicant's Management Approval Signature and Date Verifies applicant's citizenship   Certifies appropriate PIEA or Contract is in place

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Rockwell Collins Manager Signature and Date		Rockwell Collins IT Security Signature and Date