OPERATION PARTNERSHIP EMERGENCY NETWORK

Application for Participation

Please select each network you are applying for:

Security Network                             Emergency Network                        Email/Text notification             

PLEASE READ CAREFULLY:

1. Read the OPEN Protocol.
2. Read and sign the OPEN Waiver
3. Complete this application. One person per application.
4. Return by email or fax a) this printed application and b) signed waiver.
5. You will be notified by email of your acceptance into OPEN. In order to verify that email addresses were accurately provided and entered into the OPEN database, only the Notice of Acceptance will be sent to ALL email addresses provide by you below. Future emails will be sent accordingly.

Date of Application__________________________

Name of Applicant_____________________________________ Position___________________________

Your Company/Organization/Group Represented: _____________________________________________

Type of Business: _______________________________________________________________________

Business Address: _______________________________________________________________________

City: _____________________________ County: _______________ State: Texas    ZIP Code: ________

Business Phone: (      )          -       

Mobile Phone        personal or       business: ________________________________________________­_

Fax: (    )         -                  OR   I do not have a FAX number

Home: (    )       -                 

Please think through your answers to the following question. Remember, this application is for one person only----YOU. Others in your group should complete their own application.

Email address where alerts (time-sensitive Alerts and Warnings) should be sent (no more than 2 per person):

1. _______________________________________________________________________________
2. _______________________________________________________________________________       

DO NOT WRITE BELOW THIS LINE. FOR OFFICIAL USE ONLY.

Application:  Approved___________ Denied_________ Date emailed____________

Access Card Number ____________ Date of Issuance_____________________

Approved by ________________________________ Issued by ____________________

Mail, Fax or E-mail Application and waiver to:

Ofc D. Eldridge #2363

Office 817-392-3964

Fax 817-392-3985

Donna.eldridge@fortworthgov.org

Ofc. J. Cox #3256

Office 817-392-2226

julie.cox@fortworthgov.org