ATS #
Date:
Unit:
Original Request #
Unit Address:
Change #
UIC: to ATS #
Point of Contact (POC): POC Phone: DSN Phone: E-Mail Address:
Will media be coming to CRTC to support your training event?
Media POC: Media POC Phone #:
YES NO
(circle type required)
Troop
Issue
Chargeable Transient Quarters (CTQ) BOTH
Units/Organizations requesting Chargeable Transient Quarters will submit a standard name line roster (SNL) outlining requirements to Camp Ripley, ATTN: JFMN-CRC-L
POC’s:
Housing Manager: MSG Susan Ploof
(320) 616-3138 susan.m.ploof.mil@mail.mil
Assistant Housing Manager: SSG Heather Berens
(320) 616-3139 heather.r.berens.mil@mail.mil
Advance Party
Date of Arrival:
Time of Arrival:
Date of Departure:
# Officers (M)
# Officers (F)
# Enlisted (M)
# Enlisted (F)
Main Body
Date of Arrival:
Time of Arrival:
Date of Departure:
# Officers (M)
# Officers (F)
# Enlisted (M)
# Enlisted (F)
Preferred Area
Troop Issue:
Maid Service:
Other Buildings
Headquarters:
Dining Facility:
Maintenance Shelter:
Medical:
Supply:
Kitchen (list T-Bldg(s) below)
QTY
Total # Personnel: Total # Personnel:
SIZE
Large (41-96)
Medium (21-40)
Small (11-20)
Conference RM (1-10)
QTY Date(s) Required Start/End Time ITEM
Small (11-20)
TACC Kitchen
TACC Theater (204)
TACC Gym
TACC Cafeteria (240)
QTY
Date(s)
Required
Start/End Time
ITEM
Recreation Center
Hangar Conference Center
Bull Pen
Ripley Town Hall
QTY
Miller Army Airfield Manager: MAJ Nathan Foster
(320) 616-2780 nathan.a.foster4.mil@mail.mil
Remarks (to include Aviation POC and Phone #)
Date (s) Required
# Aircraft Type of Aircraft:
Start/End Time
Aviation Support Requirements (if any) Check all that apply
TOWER CRASH RESCUE COLD FUEL
** COLD FUEL IS FOR AIRCRAFT THAT ARE SHUTDOWN / FOR TRAINING PURPOSES REQUEST FUEL QUANTITIES BELOW **
ATS Form 23, dtd 17 December 2014 Page 1

NOTE: Schedule a safety brief with range control (required every 90 days to run a range), submit a deliberate risk assessment for any live fire training event, rappel tower, confidence course, field leader reaction course, and water operations.
RANGE AUTOMATION: For automated qualification ranges (A-2, A-3, A-4, NRG , and CRG) you need to write in “ALL” weapons/ammo that will be used. Under RANGE/TRAINING column Annotate “AUTO” if tower operator is needed or a nnotate “BOB” if you want targets left in up position, when TGT is hit it will go down and return to up position.
NOTE: NON-Standard qualification scenarios (i.e. vehicle gunnery/CLFX) must be submitted on RC Form 7 to Range
Control NLT 90 days.
** NO ADDITIONS/CHANGES (EXCEPT CANCELLATIONS) TO LIVE FIRE RANGES 24 HOURS PRIOR TO FIRING**
DATE TIME (START/END) RANGE/TRAINING AREA WEAPON/AMMO # PERSONNEL
YES
BIVOUAC
NO
RANGE/TA SCHEDULING: (320) 616-2709 RANGE CONTROL: (320) 616-3137
contact below:
Training Support Center: SSG Nicole Yorek (320) 616-3129 nicole.j.yorek.mil@mail.mil
POL Office: SFC Michael Fenske (320) 616-3001 michael.a.fenske.mil@mail.mil
Dates Required: POL Pt #1(MATES)
F24
POL Pt#2(Area 9)
MOGAS/F24
POL Pt#3(Area 7)
MOGARS/DIESEL
F24
Bulk Fuel
MOGAS
Quantities in Gallons
Materials Handler Supervisor: MSG Patricia Flahave (320) 616-3128 patricia.a.flahave.mil@mail.mil
Listing of Equipment Available and Logistics Information: Camp Ripley - Logistics
PICK-UP DATE/TIME:
QTY UI NOMENCLATURE
TURN-IN DATE/TIME
QTY UI NOMENCLATURE
Individual Signing for Equipment: Name: Phone:
**INDIVIDUAL SIGNING FOR THE EQUIPMENT MUST BE ON A DA FORM 1687**
ATS Form 23, dtd 17 December 2014 Page 2

ASP Supervisor: CW3 Derek Lindberg (320) 616-3167 derek.j.lindberg.mil@mail.mil
SSG Daniel Miner (320) 616-3168 daniel.j.miner4.mil@mail.mil
Circle One YES NO Will ammunition items (Class V) be required while at Camp Ripley?
If yes, have forecasts and DA 581’s been forwarded thru command channels? Circle One YES
**MUST COORDINATE WITH ASP NLT THIRTY (30) DAYS PRIOR TO TRAINING DATES**
NO
CRTC Budget Office: SFC Heike Lewandowski (320) 616-3171 DSN: 871-3171heike.m.lewandowski.mil@mail.mil
Units in Annual Training (AT) status are authorized MWR dividend. To request MWR you need to fill out an ATS Form 39
(Strength Report/Request for Morale Support Fund Dividends) and turn it into NGMN-CRB
Contract Dining Facility Information: Contract Dining Facility Request
Contracting Officers Rep: SFC Christopher Degeest (320) 632-7431 christopher.a.degeest.mil@mail.mil
Defense Movement Coordinator: 1LT Andrew Ebert (320) 616.2680 andrew.f.ebert2.mil@mail.mil
Transportation Officer: MAJ Gordon Giswold (320) 616-2681 gordon.p.giswold.mil@mail.mil
Communication Needs for Minnesota National Guard Organizations:
1) Use your BN-BDE-34 th _ID IMO for requests
Communication Needs for Non-Minnesota National Guard Units and Organizations:
1) Verify your reserved building/room is internet capable – Internet Capable Building
You may need to schedule a different building to accommodate your unit or agencies needs
2) Contact the Camp Ripley IMO no less than 30 days prior to arrival date at Camp Ripley
Failure to contact the Camp Ripley IMO at least 30 days prior to arrival at Camp Ripley Training Center (CRTC) will result in denial of requests.
Camp Ripley IMO: CW3 Scott Bjerke (320) 616-2702 scott.a.bjerke.mil@mail.mil
Coordinate use at: 320-616-3152
(Medical Purposes/Training Only)
Coordinate use at: 320-616-2666
(Use of Drill Floor will be entered on RFMSS)
Coordinate use at: 320-616-2708
(Use of EMTC will be entered on RFMSS)
**Send ATS Form 23 to SFC Joseph Cheney at joseph.e.cheney.mil@mail.mil
or call 320-616-2709
Please cc ATS Form 23 to CPT Adam Stock at adam.j.stock2.mil@mail.mil
Camp Ripley Training Center
ATS Form 23, dtd 17 December 2014 Page 3