Register Council

THIS PAGE IS TO REGISTER OFFICIAL CITIZEN CORPS COUNCILS ONLY
If you are not an official representative of a Citizen Corps Council, but are interested in participating in Citizen Corps please join our Mailing List

Thank you.

FOR LOCAL OFFICIALS:

Thank you for your interest in bringing Citizen Corps to your community. We are creating a directory of Citizen Corps Councils to help build a network of communities that are committed to engaging their citizens in being safer and better prepared for all emergency situations.

Through this network, your state and federal partners will be able to share relevant information with you and you will be able to exchange information with your counterparts. Please complete each field and submit this form only once for your Council. Once your information has been verified, we will post your Council on the Citizen Corps website. Thank you!

Council Information


Council Name*
Region Name*
Council Type*
Street Address*
Street Address Cont.
City*
State*
Zip Code*	-
Phone Number*	- - Ext:
Council's Email	(xxx@yyy.zzz)
Confirm Email	(xxx@yyy.zzz)
Council Web Site	(http://www.xxx.com)
Council Description

Council's Endorsing Local Official

It is important to have the support of the local elected leadership for your Council's jurisdiction - this could be the Mayor, City/Town Manger, County Commissioner - or the Emergency Management Director for your area. Please be sure your contact supports your interest in forming a Citizen Corps Council before submitting their name.


First Name*
Middle Initial
Last Name*
Title
Street Address*
Street Address Cont.
City*
State*
Zip Code*	-
Phone Number*	- - Ext:
Email*	(xxx@yyy.zzz)
Confirm Email*	(xxx@yyy.zzz)

Council's Point Of Contact

Council Point of Contact: This is the principal point of contact for Citizen Corps in your community. This is the person who will receive information from state or federal partners and whose name and email address will be posted on the Citizen Corps website. You may wish to create a generic email address, such as CitizenCorps@dhs.gov


First Name*
Middle Initial
Last Name*
Title
Street Address*
Street Address Cont.
City*
State*
Zip Code*	-
Phone Number*	- - Ext:
Fax	- - Ext:
Email*	(xxx@yyy.zzz)
Confirm Email*	(xxx@yyy.zzz)

Council's Covered Jurisdictions

No Jurisdictions are currently associated with this council.

OMB No. 1660-0079, Expiration Date: 07/31/2006