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Member Registration
* Required 

CONTACT INFORMATION
First Name:  *

Last Name: *

Position/Title/Rank:  *

Agency/Organization Name:  *

Zone: * (View Zone Map)

Business Phone Number:  *

Cell/24 Contact Number:

Email Address:  *  (must be an agency address)

Please re-type your email address: *


Member Agency Affiliation (Law Enforcement Only) *
 I am the primary member agency contact
 I am the alternate member agency contact
 I am a member of a dues paying agency

Agency Representative Full Name (Primary or Alternate Contact on File with LEIU) *

Agency Representative Email Address (Primary or Alternate Contact on File with LEIU)  *


Sharing Group Access Request (Optional)
 No sharing group access requested
 National Gambling Intelligence Sharing Group
 National Corrections & Custodial Intelligence Sharing Group

COMMENTS (Optional)

WEBSITE ACCESS
Password: *
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.