Step #1: Organizational Information Sheet
Email address *
Our organization is applying as: *
Membership Dues:
If annual revenue is less than $250,000, then dues = $50.
If annual revenue exceeds $250,000, but is less than $1 million, then dues = $100.
If annual revenue exceeds $1 million, then dues = $200.

Make all checks payable to: Emergency Network Los Angeles, Inc.

Mailing Address:
Emergency Network Los Angeles, Inc.
5211 E Washington Blvd, Ste #2-294
Los Angeles, CA 90040
Annual Revenue: *
Amount Enclosed: ($)
General Information
Legal Name of Organization/Business: *
Address:
Website:
Phone:
Fax:
ENLA Liaisons
Name of Executive Director/Senior Clergy: *
Primary Liaison to ENLA: *
Liaison Phone: *
Liaison E-mail: *
Liaison Fax:
Secondary Contact:
Secondary Phone:
Coverage Areas
We are located in Disaster Management Area (DMA) *
Required
Services Provided/Available
Select 3 of the below service classes
Service classes corresponding to your agency *
Required
ENLA Committees
Select the below committees you (and your agency) are interested in joining
Committee groups to join
Is your organization interested in hosting an upcoming meeting?
Clear selection
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