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OPERATION PARTNERSHIP EMERGENCY NETWORK
Application for Participation
PLEASE READ
CAREFULLY:
- Read the
OPEN Protocol.
- Read and
sign the OPEN Waiver
- Complete
this application. One person per application.
- Return by
mail or fax a) this printed application and b) signed
waiver to:
Operation Partnership Emergency
Network, c/o Fire Department, City of Fort Worth,
1000 Throckmorton St., Fort Worth, TX
76102, Fax 817-922-3030
- You will be
notified by email of your acceptance in OPEN. In order to verify
that email addresses were accurately provided and entered into
the OPEN database, only the Notice of Acceptance will be sent to
ALL email addresses provide by you below. Future emails will be
sent accordingly.
Name of
Applicant:
______________________________________________________________________
Your
Company/Organization/Group Represented:
_____________________________________________
Type of
Business:
_______________________________________________________________________
Business
Address:
_______________________________________________________________________
City:
_____________________________ County: _______________ State:
Texas ZIP Code: ________
Business Phone:
( ) -
 Mobile
Phone personal or business:
___________________________________________________
Fax: (
) - OR, I do not have a FAX number
Home: (
) -
-
Please think through your answers to the following question.
Remember, this application is for one person only----YOU.
-
Others in your group should complete their own application.
Email address where alerts (time-sensitive Alerts and
Warnings) should be sent (no more than 2 per person):
-
_______________________________________________________________________________
-
_______________________________________________________________________________
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