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2018 County Contacts List Update

2. Instructions
   The Madison County Office of Emergency Management maintains a municipal contacts list as part of the Comprehensive Emergency Management Plan (CEMP). This information is used FOR OFFICIAL USE ONLY during natural or manmade disasters, and is not shared with other parties. Please complete this electronic form and click submit. Thank you.

   The Madison County Office of Emergency Management maintains a municipal contacts list as part of the Comprehensive Emergency Management Plan (CEMP). This information is used FOR OFFICIAL USE ONLY during natural or manmade disasters, and is not shared with other parties. Please complete this electronic form and click submit. Thank you.

4. Name of Department/Agency
   -- Select One --Town of BrookfieldBoard of ElectionsBoard of SupervisorsCentral ServicesCounty AttorneyCounty ClerkDistrict AttorneyFacilitiesHighwayInformation TechnologyMental HealthPersonnelPLanningProbationPublic HealthPurchasingReal PropertySheriff's OfficeSocial ServicesSolid WasteTreasurer's OfficeVeteransEmergency Management

6. Office Phone Number

7. Office Fax Number

11. Director/Commisioner Name

12. Director/Commisioner Home Phone

14. Director/Commisioner Cell Phone

15. Director/Commisioner Email Address

19. Deputy Director/Commisioner Name

20. Deputy Director/Commisioner Home Phone

22. Deputy Director/Commisioner Cell Phone

23. Deputy Director/Commisioner Email

27. Next in Line of Succession - Name

28. Next in Line of Succession - Home Phone

30. Next in Line of Succession - Cell

31. Next in Line of Succession - Email

35. Next in Line of Succession - Name

36. Next in Line of Succession - Home Phone

38. Next in Line of Succession - Cell

39. Next in Line of Succession - Email

43. Next in Line of Succession - Name

44. Next in Line of Succession - Home Phone

46. Next in Line of Succession - Cell

47. Next in Line of Succession - Email

51. Comments

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53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

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