« AGREEMENT 
In accepting the authorization granted to me by the United States Government, as represented by the 
U. S. Navy and the National Science Foundation, to utilize transportation and facilities provided in support 
of the U. S. Antarctic Research Program, i have agreed to the following conditions: 
1. That while accompanying the Naval Forces outside the territorial limits of the United States, I am 
subject to the provisions of Annex N of the current Commander, Task Force FORTY-THREE Operation Plan and to 
such other regulations as may be agreed upon by the National Science Foundation and the Department of Defense 
2. That ! recognize the responsibility and authority of the Officer in Charge of each of the united 
States stations in Antarctica to take all necessary and proper measures in accordance with law and regula- 
tions to promote and safeguard the physical well-being, the morale and general welfare of all personnel as- 
signed to his station: and 
3. That upon termination of my participation In the program, 1 will return my travel credentials to 
the Chief of Nava! Operations or to his authorized representative, as directed. 
I, — , do solemnly swear (or affirm) 
that I agree to these conditions freely, without any mental reservat Ions or purpose of evasion. 
DATE 
SIGNATURE 
Subscribed and sworn to before me this 
at 
day of 
id 
(Si gnature 
of 
Official A dm inis t er ing 
Oa th ) 
(Official Capacity ) 
Note : This form will be executed in triplicate. 
Di st ri buti on 
r 
Original to - Chief of Naval Operations 
to - Sponsoring Bureau or Office 
retained by - Civilian concerned 
(Op-09B21E) 
OPNAV FORM 5720-6 (NEW 9-61 ) 
0P-09B21E 
A- 12636 
