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2. Borough Emergency Alert System Registration
   We are implementing a new emergency alert system for borough employees. Please complete the below form to be added to the new system.
   
   For questions, please contact Michael Pellessier at
   pellessierm@rosenet.org or 973-408-8789
   
   If you are already registered for AlertMadison, a secondary account and/or a categorization as "borough employee" will be applied to your existing account.
3. 
7. First Name*
8. Last Name*
10. Department*
11. Notifications*

    What type of emergency alert notifications would you like to receive? (Select any/all from the below list)

    1. Text Message
    2. Phone Call
    3. Email
13. Cell Phone Number*
    This should be a number which can receive text messages
15. Home Phone Number
    If you wish to receive a phone call on a number other than your cell phone, please enter that number above
17. Email Address*
    This should be an email address which you check frequently
21. By submitting this information, you acknowledge and agree that you provide consent to release all your information to The Borough of Madison for emergency communication use.
    
    It is the responsibility of the employee to notify their supervisor if their contact information changes.
    
    This service, a product of Rave Wireless, Inc., is compatible with the products and services provided by AT&T, Sprint, Verizon Wireless, TMobile, and most other mobile phone carriers.
23. Electronic Signature*
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field