Please provide the information requested below to register for the 2023 Coalition Contract Challenge on Thursday, September 28th, 2023.  Healthcare facilities, organizations, and partners are welcome to participate.

Once registered, you will receive an alert at 10am on September 28th to contact all organizations that you have contracts or MOAs with, as part of your disaster plan, to confirm them.  We will provide a list of optional questions to ask them.  Once completed, you'll submit documentation (that we will provide you) back to us, and we will develop and disseminate an After Action Report!

Following registration, you will receive additional instructions via email.

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* 1. Organization Name:

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* 2. What type of group do you represent?

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* 3. Organization Address (including city, state & zip):

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* 4. County(ies):

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* 5. Organization Point of Contact (POC) Name:

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* 6. POC Email Address: 

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* 7. POC Phone Number: 

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* 8. Please estimate the number of people in your organization that will participate in the 2023 Coalition Contract Challenge:

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