Privacy and Non-Disclosure AgreementIf accepted as a member of San Antonio Railroad Heritage Museum (“SARHM”) and/or its subsidiaries, Applicant may receive information that is sensitive and not publicly available (“Protected Information”). Protected Information may be provided by or through SARHM, SARHM chapters, SARHM members, partners of SARHM, sub-chapters of SARHM, subsidiaries of SARHM, or other sources (“SARHM, et al”), and will be marked accordingly. If accepted as an SARHM member, Applicant understands and agrees to the following terms regarding Protected Information:
1. Participation is Voluntary. The applicant is not obligated as a condition of SARHM and/or its subsidiaries membership to disclose any information to SARHM or SARHM, et al.
2. Confidentiality and Non-Disclosure. Protected Information is to be regarded as Business Confidential and shall not be disclosed beyond its intended scope.
3. No guarantee of fitness. Protected Information is provided as a service to SARHM and/or its subsidiaries members and may be unevaluated and unverified. As such Protected Information is not guaranteed to be accurate, complete, or actionable.
4. Submission in Good Faith. Applicant agrees that it will not submit information which it knows at the time of submission to be false, and that it will submit information only to further SARHM’s and/or its subsidiaries’ stated purposes.
5. Federal Agencies will exercise care to protect information. To the extent allowed by law, information received from SARHM and/or its subsidiaries members that is marked “SARHM and/or its subsidiaries Protected Information” shall be protected from agency disclosure under 5 USC §552 (commonly referred to as the Freedom of Information Act (“FOIA”)), and from publication, divulgence, or release in any other manner pursuant to the prohibitions of the Trade Secrets Act, 18 USC §1905.
Applicant understands and agrees that SARHM and/or its subsidiaries is not to be commercially exploited as a forum to market products or services and that doing so may result in the revocation of Applicant’s membership in SARHM and/or its subsidiaries. The applicant, if accepted as an SARHM and/or its subsidiaries member, agrees to act in a manner consistent with the SARHM By-Laws, as the By-Laws may be amended from time to time, as well as any other duly enacted requirements of SARHM and/or its subsidiaries.
• US Citizen by birth as defined by 8 USC §1401-§1409, OR US Citizen by Naturalization as defined by 8 USC §1421-§1459;
• Over 18 years of age on the date of completion of this Application;
• Consent to a records check that yields a satisfactory result as determined by SARHM and/or its subsidiaries in its sole discretion, OR posses Qualifying Substitute;
• Consent to periodic re-confirmation of membership requirements;
• Have sponsorship from an existing SARHM, et al;
• Agree to and complete this SARHM Membership Application Form;
• Any further requirements (if more restrictive) mandated by the local chapter and approved by SARHM and/or its subsidiaries.
Applicant acknowledges that their affiliation with SARHM and/or its subsidiaries may be disclosed by SARHM and/or its subsidiaries to another SARHM, et al. Applicant may choose to protect from public disclosure their affiliation with SARHM and/or its subsidiaries, and request that SARHM and/or its subsidiaries and SARHM Partners also protect from public disclosure the Applicant’s affiliation with SARHM and/or its subsidiaries to the full extent permitted by law.
PRIVACY ACT STATEMENT AND CONSENTAuthority:
Collection of this information is authorized under 28 CFR. § 0.85.
Principal Purpose and Routine Uses
The information collected on this form will be used for the principal purpose of conducting security risk assessments on SARHM and/or its subsidiaries Members and applicants. As part of this assessment, the collected data may also be used to assist in determining approval, denial, revocation or renewal of access to the SARHM and/or its subsidiaries Secure web site and the authorization to receive SARHM and/or its subsidiaries sensitive information. Information provided by SARHM and/or its subsidiaries will be protected and used in strict compliance with the Privacy Act and the routine uses most recently published in the Federal Register for the FBI's Central Records System (Justice/FBI-002) and the FBI’s Blanket Routine Uses (Justice/FBI-BRU).
Effects of Nondisclosure or Falsification
Completion of this application and is voluntary. However, failure to provide the requested information may result in your application being rejected for membership in SARHM and/or its subsidiaries or your membership revoked. Knowingly falsifying or concealing information requested on this form will result in your application being rejected or your membership revoked. In addition, Title 18 Section 1001 of the U.S. Code provides that knowingly falsifying or concealing a material fact may under certain circumstances constitute a felony resulting in fines and/or imprisonment.
By signing a SARHM Membership Application Form, I hereby authorize the FBI to obtain and verify any
information relevant to assessing my suitability to access, possess, use, receive or transfer sensitive SARHM and/or its subsidiaries Information. This information may include, but is not limited to, law enforcement and intelligence information. I further authorize the FBI to disclose information obtained in connection with my security risk assessment in order to verify the accuracy or completeness of the information I have provided to the FBI. Other than to verify my information, I do not authorize the FBI to disclose for the purpose of conducting my security risk assessment information provided by me on this form absent my further written consent.
Paperwork Reduction Act Notice
The information required on this form is in accordance with the Paper Work Reduction Act of 1995. The purpose of this information is to assist the FBI in security risk assessments for entities and individuals who are SARHM Members or applicants. The estimated average burden associated with this collection of information is 20 minutes, depending on circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to Federal Bureau of Investigation, Records/Information Dissemination Section, 935 Pennsylvania Ave., N.W., Washington, DC 920535.
I understand that this is a legally binding document and false statements provided by me are violations of federal law and may lead to criminal prosecution or other legal action. To the best of my knowledge and belief, I affirm that a). I meet all of the requirements to be a SARHM and/or its subsidiaries member; and b). The information I have provided herein is true, complete and correct.