NGISG Sharing Group RegistrationIf you are already a LEIU Member, do not complete this form. Email firstname.lastname@example.org to request access.* Required CONTACT INFORMATIONFirst Name: *Last Name: *Position/Title/Rank: *Agency/Organization Name: *Assignment / Role within agency: *Does your LE Agency/Gaming Office Oversee: *Regulation OnlyRegulation and EnforcementEnforcement OnlyZone: * (View Zone Map)- Select -EasternCentralNorthwesternSouthwesternBusiness Phone Number: *Cell/24 Contact Number:Email Address: * (must be an agency address)Please re-type your email address: *SUPERVISOR INFORMATION CONTACTFull Name: *Supervisor's Title: *Phone Work: * Supervisor's Email Address: *(Agency/Organization Email Addresses Only)EXPERTISE (Optional)Will display on Sharing Group Roster / Directory (if applicable)
WEBSITE ACCESSPassword: *Create a password for site access / modify your contact information. (min 8 characters; 1 numeric, 1 special)
All registration information is considered strictly confidential and will not be shared.