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AKEMA Registration & Contact information
Please fill out the fields below.
* Indicates required question
Email
*
Your email
Last Name
*
Your answer
First Name
*
Your answer
Organization
*
Your answer
Mailing Address
*
Your answer
City
*
Your answer
State
*
Your answer
Postal Code
*
Your answer
Phone Number (Office)
*
Your answer
Phone Number (Mobile)
*
Your answer
Email
*
Your answer
Email (Alternate)
Your answer
Emergency Management Professional Discipline (may select more than one if applies)
*
Emergency Management
Fire Department
Police Department
Emergency Medical/Response Services
Healthcare
Safety
Local Emergency Planning Committee
Volunteer
Student
Alaska Libraries, Museums, and/or Cultural Centers
Other
Required
Organization Type (may select more than one if applies)
*
Local
State
Federal
Tribal
Private Business
Education (K-12)
Higher Education
Non-Governmental Organization
Required
Membership Type
*
Individual ($50)
Student ($25)
Volunteer ($10)
Payment Options
*
Cash
Personal Check
Purchase Order
Venmo
Date of Payment (For PO's or payments to be made at a later date - please use the date '
12/12/2024
' and an invoice will be sent to your email)
*
MM
/
DD
/
YYYY
Other Related Information (optional) (Facebook/Instagram/'X'/LinkedIn profiles)
Your answer
Can AKEMA release your contact information to other AKEMA members?
*
Yes
No
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