Emergency Identification
Adding to Database

This form is used to add 5 or fewer names to the emergency ID database. Please do not submit this form repeatedly to add more than 5 names. If you need to add more than 5 names click one of the other buttons after using your browser's Back button.

In the first section you must supply the Department ID. Failure to provide this information will result in an error. If you do not have a Department ID then you must provide a complete registration. If you need to make a change in your department's registration information, go back to the previous form and select Update Department Information either now or after you complete this form.

BOTH FIELDS ARE REQUIRED
Department ID
Contact's email

NAMES TO ADD TO DATABASE


Last name
First name

Last name
First name

Last name
First name

Last name
First name

Last name
First name

   
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Indiana University
Office of Risk Management
400 E. 7th Street Room 705, Bloomington, IN 47405
812-855-9758 FAX 812-855-9320
A division of the Office of the Vice President for Administration, Chief Administrative Officer

Last updated: 20-Mar-2003
Comments: Webmaster
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