Join - Chicago Healthcare System Coalition for Preparedness and Response

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Hospital EP

Non-Hospital Partner

General

First Name *

Last Name *

Title

Role

Work Email *

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Office Phone

Mobile Phone

Organization Name Organization Name

To select multiple organizations, please use CTRL+Click.

Facility Type Facility Type

Address

City

State

Zip Code

Does your organization serve the city of Chicago?

Yes

No

Are you the primary or secondary person responsible for emergency preparedness/emergency management at your organization?

Yes

No

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Are you requesting access to EMResource? EMResource access is limited to Region 11 (Chicago) hospitals, long-term care facilities, and dialysis centers. The primary EMResource contact at your organization will be notified. More Information on EMResource

Yes

No (I Don't Need or Want Access)

No (I Already Have Access)

Do you have interest in joining any Coalition Committees? Committees generally meet monthly (October-June) and regular attendance/participation is required. More Information on Coalition Committees

Yes

No

Please check all that apply.

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I understand that by becoming a member, I will receive periodic email communications from the Chicago Healthcare System Coalition for Preparedness and Response, including but not limited to, situational awareness, training opportunities, and meeting requests.

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Registration Join the Chicago Coalition