Name* First Last Organization/Facility Name*Job Title*Work Phone*Mobile Phone*Used for urgent contact during incidents.Email*This is the email address where you'll receive alerts and messages. HIddenSelect which list you plan to subscribe to. NSPA staff routinely sends alerts to multiple lists to include all effected stakeholders. Hospital/ED/Portal of Entry HealthcarePublic HealthEMA (include local, state, and PSAP)EMS/Private Transport (FD and EMS Council)LTC/Assisted LivingDialysisHome Care/HospiceBehavioral HealthFuneral HomesLaw EnforcementHigher EducationInfection PreventionAmateur RadioOther Key ContactsChoose the most appropriate sector(s) from the list below:*Note: You will only be allowed to subscribe to lists that are appropriate for your role in regional healthcare preparedness. Hospital/ED/Portal of Entry Healthcare Public Health Emergency Management Agency EMS/Patient Transport LTC/Assisted Living Dialysis Home Care/Hospice Behavioral Health Decedent Services Law Enforcement Higher Ed. Infection Prevention Amateur Radio/Comms IT Pharmacy Geography*Some incidents may only affect a portion of our region. Select the most pertinent geography for your facility. Selection of more than one choice is okay. Roanoke Area New River Valley/Pulaski Patrick/Henry Co./Danville Lynchburg Alleghany Highlands Ready to submit?*Yep!