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Exercise Portal Registration
Username (login)
Password (login)
E-mail Address
Tell us about your job (check all that apply):
Public Health Leader/Official (department head, bureau chief, director, etc.)
Bioterrorism Coordinator
Hospital Administrator/ Management
Physician
Nurse Practitioner/Physician Assistant
Nurse
Medical Examiner/Coroner
Community Health Worker
Social Worker/Counselor
Nutritionist/Dietician
Environmental Health Specialist/Sanitarian
Epidemiologist
Communicable Disease Specialist/Disease Intervention Specialist
Public Information Staff (media spokesperson, public relations staff, media liaison)
Laboratorian
Dentist
Mortician
Pharmacist
Veterinarian
Support staff (administrative assistant, clerk, etc.)
Health Educator or Trainer
Elementary or Secondary Teacher
Higher Education Teacher/Professor
First Responder (EMT, paramedic, fire, rescue, HazMat., etc.)
Law Enforcement (police, state patrol, FBI, etc.)
Emergency Management (FEMA, County, City, or Municipal EMA civil defense, etc.)
Law/judicial/attorney
Elected government official
Researcher
Librarian/Informatician
Computer/technology
Other (please specify):
Tell us about the organization you work for:
State health department/jurisdiction
Local public health department/jurisdiction
Hospital
Community health clinic
Physician group
College or University
Government (local, state, federal)
Law enforcement/ fire/ emergency response
Association or interest group
Elementary or secondary school
Business
Service organization
Other (please specify):
Tell us about the service area of your organization:
Local: city or single county
Multi-county, but not statewide
Statewide
Multi-state, but not national
National
Other (please specify):
Tell us about the population your organization serves:
Metropolitan area (>50,000)
Large town (10,000-49,000)
Small town (2,500-9,999)
Rural (<2,500)
