Emergency Measures Organization Advanced Course Application

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Personal information is collected on this form under section 31(c) of the Freedom of Information and Protection of Privacy Act and will be used only for the provision of Emergency Management Training by the PEI Emergency Measures Organization. If you have any remaining questions, you can contact the PEI Emergency Measures Organization office at 902-894-0385.

Identification

First Name

Middle Initial

Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Organization I represent

My emergency position within the organization