Everbridge Facility Registration

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* 1. Do you currently have an Everbridge Login?

Yes

No

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* 2. Is your facility currently using Everbridge?

Yes

No

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* 3. What is the name of your facility?

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* 4. Please select your Healthcare Coalition Region?

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* 5. Please enter name of a contact person for your facility?

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* 6. Please enter an email address for the person named in question 3?

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* 7. Please choose your facility type

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* 8. Please choose the role for your contact person

Managing Contacts and sending messages

Sending Messages Only

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* 9. Other comments