Please be advised that the registration is full and by submitting this form you will be placed on a wait list. If a spot becomes available, you will be reached by email in the order as listed on the wait list. Question Title * 1. Please provide all of the required information to register for this seminar. LAST name * FIRST name * Rank / Title * Agency / Organization Email * State -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Agency Street Address (i.e. 24 Main Street) * Agency City / Actual Work Place Agency Postal Code Question Title * 2. Continue Agency Phone Number * Extension (if applicable) Agency Fax Number * Personal Phone Number Supervisor Name * NJlearn ID (If Known) FEMA SID Number (REQUIRED*) * *If you do not already have a FEMA SID or need to retrieve one, please go here: Click here Question Title * 3. Agency County Out-of-State Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren Question Title * 4. Agency Region Out-of-State Delaware River: Burlington, Camden, Cumberland, Gloucester, Mercer, Salem Northwest: Hunterdon, Somerset, Sussex, Warren Shore: Atlantic, Cape May, Monmouth, Ocean UASI: Bergen, Essex, Hudson, Morris, Middlesex, Passaic, Union Question Title * 5. Agency / Organization Jurisdiction County Federal Municipal Out-of-State / Other Private Sector Public Authority State Question Title * 6. Responder Discipline Corrections Emergency Management Emergency Medical Services Fire Service Governmental Administrative HazMat / Explosive Law Enforcement NJ National Guard / Military Private Sector / Other Public Safety Communications Search / Rescue Submit