Elected Officials Workshop Registration Form

Elected Officials Workshop Registration Form

<p>North Carolina Department of Public Safety</p><p>Emergency Management</p><p>Beverly Eaves Perdue, Governor Reuben F. Young, Secretary H. Douglas Hoell, Jr., Director</p><p>INCIDENT COMMAND SYSTEMS (ICS) OVERVIEW FOR EXECUTIVES AND SENIOR OFFICIALS STATE OF EMERGENCY LEGAL ISSUES</p><p>Date: March 14, 2012 Location: Sea Trail Conference Center, Sunset Beach, NC</p><p>Please fax or email this registration form to the attention of Dianne Benton at 919- 825-2684 or [email protected]. </p><p>Name (please print clearly): Last First M.I.</p><p>Business Address: </p><p>Daytime Phone: ______</p><p>Email Address: ______</p><p>County/City: ___ Position / title: </p><p>Please check the sessions you will be attending. Also, please check if you will be present for lunch:</p><p>_____Incident Command Overview for Executives and Senior Officials</p><p>_____State of Emergency Legal Issues</p><p>_____Lunch</p><p>MAILING ADDRESS: OFFICE LOCATION: 4713 Mail Service Center 1636 Gold Star Drive Raleigh NC 27699-4713 Raleigh, NC 27607-3371 Telephone: (919) 825-2500 www.ncem.org Fax: (919) 825-2685 An Equal Opportunity/Affirmative Action Employer 2EM FORUM</p><p>Do you have a disability that would require special consideration during your course attendance? If so, please explain what we can do to accommodate your needs: </p><p>______</p><p>MAILING ADDRESS: OFFICE LOCATION: 4713 Mail Service Center 1636 Gold Star Drive Raleigh NC 27699-4713 Raleigh, NC 27607-3371 Telephone: (919) 825-2500 www.ncem.org Fax: (919) 825-2685 An Equal Opportunity/Affirmative Action Employer</p>

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