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Twin Lakes Regional Medical Center

Duty Contact Information

The information requested will be used for notifying you in the midst of an emergency on campus or in the immediate vicinity.
Please fill out the information below. It is vital that we receive the most up to date information in order to ensure message delivery in an emergency.
Associated Event   
* First Name
* Last Name
* Title
* Department
Phone Number #1
* Phone Number
Example: 205-752-5050
 
Please indicate extension, if applicable.
*
Please indicate phone type.
 
if cell, please indicate carrier
Phone Number #2
  Phone Number
Example: 205-752-5050
 
Please indicate extension, if applicable.
 
Please indicate phone type.
 
if cell, please indicate carrier
Phone Number #3
  Phone Number
Example: 205-752-5050
 
Please indicate extension, if applicable.
 
Please indicate phone type.
 
if cell, please indicate carrier.
Phone Number #4
  Phone Number
Example: 205-752-5050
 
Please indicate extension, if applicable.
 
Please indicate phone type.
 
if cell, please indicate carrier
Additional Communication Methods
  LINC/Radio ID
* Primary E-mail Address
  Alternate E-mail Address
Primary Address
* Street Address
* City
* State
* Zip Code
Secondary Address
  Street Address
  City
  State
  Zip Code
Comments
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