EM - Community Organizations Active in Disasters Registration

Organization Name *

Organization Type *

Category *

Please select the category that you feel best describes the mission of your organization. Check all that apply.

Category Comments

Organization Address *

Address Line 1

Address Line 2

City

State

Zip Code

County *

Please select the primary County in which your organization is located.

Public Contact Phone Number *

Public phone number that can be published for contacting your organization.

Emergency – 24/7 Contact Number (Non-Public) *

24/7/365 number COAD leadership can reach you.

Contact Name *

First

Last

Contact Position / Title (copy) *

E-Mail Address *

Meeting Preferences *

What days would be best for your organization to attend a meeting of the COAD?

Meeting Format Preferences *

What platform would be best for your organization to attend a meeting of the COAD?

Services & Resources *

Please list any services or resources your organization would be able to provide to the public in a disaster.

Comments *

Please list any comments or general information concerning your organization.

EM – Community Organizations Active in Disasters Registration