Emergency Resources Database

2. Emergency Resources Database - Submission Tool
   
   

   Have Equipment or Resources That Could Help?

4. Name*
5. Email Address*
7. Address
9. City
10. Prov
11. Postal Code
13. Phone Number*
15. Description of Equipment/Resource*
17. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
19. Electronic Signature
21. Protection of Privacy Act

    The personal information collected through the Emergency Resource Database form is for the purpose of collecting equipment and resources for emergency management. This collection is authorized under section 4(c) of the Protection of Privacy Act. For questions about the collection of personal information, contact the Privacy Office LegislativeServices@DiamondValley.town or 403-933-4348.

Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field