Office of Emergency Management

AboutLEPCMembership Form


Membership Application


(Effective Date: 2008 - 2009)
LOCAL EMERGENCY PLANNING COMMITTEE
2009 Executive Board

Todd Gregory - Chair
Tim Zagorski - Vice Chair
Ron Camnunez - Secretary
Carey Latesa - Treasurer
Delia Cervantes - OEM Representative


Please complete as much of the form as you can. Fields with an asterisk (*) are required.


* Membership Type
New
Renewal

* Voting Rights
Member Without Voting Rights
Member With Voting Rights - Amount Due $20.00 (per year)


* Name:
Title:
Agency:
Address:
City/State/Zip:
Work Phone:
Home Phone:
Fax:
Pager:
Mobile:
* E-mail:

Why do you want to be a member of the LEPC?


What would you be able to contribute to the LEPC?


* Which Sub-Committee(s) would you like to serve on?
Committee Awareness / Education / Membership
Exercise / Planning / Development
Finance


* Which All Hazard Emergency Operation Planning Committee(s) would you like to serve on?
Hazmat Facility / Transportation
Public Health and Medical
Natural Hazard


* Agency Affiliation (please select one):

Municipal/State Government Local Elected Official
Law Enforcement Emergency Management
Fire Services EMS/Medical Response
Health Professional Local Environment
Hospital/Clinic Transportation
Broadcast/Print Media Community Agency
Facility Operator subject to EPCRA National Weather Service
Military Federal Facility
Correctional Facility Public Schools
University/College Private Citizen
Other



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