NWRHCC Activation Request
The following information is required in order to process your request. A member of the NWRHCC Leadership team will be in contact with you shortly; if you have not heard from an NWRHCC Leadership member within 30 minutes please resubmit this form.

Thank you,

NWRHCC Leadership Team

First Name *
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Last Name *
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Organization Name *
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E-mail *
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Phone Number *
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I am requesting the NWRHCC be activated to support regional response coordination for a healthcare emergency.
Please provide a detailed explanation of why you are requesting activation of the NWRHCC. *
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