Antimicrobial Resistance Lab-Epi Alliance Sign Up Contact Information Thank you for your interest in the California Antimicrobial Resistance Lab-Epi Alliance. Please complete the form below to let us know more about your organization and its primary contacts. Question Title * Name of your facility, institution, or local public health agency Question Title * Primary Contact- Please enter a name, title, and preferred email address for the primary contact for your organization First Name Last Name Title Preferred Email Address Question Title * Please indicate the primary role of the contact listed above Clinical Lab Scientist Microbioloy Director/Manager Healthcare Epidemiologist Other (please specify) Question Title * The facility, institution, or local public health agency listed above is best described by which of the following (mark all that apply): Clinical Laboratory Public Health Laboratory Public Health Agency Single Acute Care Hospital Multiple Acute Care Hospitals Skilled Nursing Facilities Academic Center Other (please specify) Next