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Coordinator Information
Name:
Email Address:
Building(s):
Type: - Primary
- Alternate
Office Phone: - 225-578-2327 format
Office Location:
Emergency # Home: - 225-578-2327 format
Emergency # Cell: - 225-578-2327 format
Emergency # Other: - 225-578-2327 format
If you are unavailable please list at least one other contact incase of any emergency
Emergency Contact 1 Name:
Emergency Contact 1 Email Address:
Emergency Contact 1 Work #: - 225-578-2327 format
Emergency Contact 1 Home #: - 225-578-2327 format
Emergency Contact 1 Other #: - 225-578-2327 format
Emergency Contact 2 Name:
Emergency Contact 2 Email Address:
Emergency Contact 2 Work #: - 225-578-2327 format
Emergency Contact 2 Home #: - 225-578-2327 format
Emergency Contact 2 Other #: - 225-578-2327 format
If there are any vital areas in your buildings that has to have utilities for prolong outages, please fill out the following
Vital Contact 1 Name:
Vital Contact 1 Email Address:
Vital Contact 1 # Work: - 225-578-2327 format
Vital Contact 1 # Home: - 225-578-2327 format
Vital Contact 1 # Other: - 225-578-2327 format
Vital Contact 2 Name:
Vital Contact 2 Email Address:
Vital Contact 2 # Work: - 225-578-2327 format
Vital Contact 2 # Home: - 225-578-2327 format
Vital Contact 2 # Other: - 225-578-2327 format

 

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