HEALTHCARE / PUBLIC HEALTH RegistrationWho should register? Partners with a "right" and "need-to-know" sensitive public safety information who are currently employed in a public health role, such as infectious and communicable diseases, food and water safety, emergency medical services, hazardous material management, and government hospitals; have attended a Terrorism Liaison Officer (TLO) Basic course or (ILO Basic training course via InfraGard); and submitted a copy of their TLO/ILO certificate to JRIC for verification (via email to email@example.com). Subscription email addresses must be agency-affiliated. No group or personal email addresses.
(for registration purposes only)First Name *Last Name *Position/Title: *Phone Work: *Mobile Phone:Email Address: *(Use company / organization email address)Retype your e-mail address: *
AGENCY / ORGANIZATIONAgency/Organization Name: * (no abbreviations)Current Assignment: *(Spell out - no acronyms)Describe Your Current Duties, Role and Responsibilities * Address: *Address 2:City: *County: * - Select County -Los AngelesOrangeRiversideSan BernardinoSanta BarbaraSan Luis ObispoVenturaOther
State:*Zip code:*SUPERVISOR INFORMATIONSupervisor Full Name: *Supervisor Phone: *Supervisor Email Address: *PROFILE ACCESSPassword: *(Create a password for site / must be 8 characters minimum 1 numeric and 1 special)All registration information is considered strictly confidential.