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2. For Member Contact UPDATES (not Addition or Removal) Please Email the Request Directly to MemberServices@LGIT.org
4. Please complete the following form to ADD a Member Contact
6. Requester Details
8. Requester's First Name*
9. Requester's Last Name*
11. Requester's Phone Number*
12. Requester's Email*
14. Local Government (City / Town / County):*
18. Contact Details
20. First Name*
21. Last Name*
22. Title*
24. Phone*
25. Email*
27. Address*
29. Contact Role(s)

    1. Administrative Contact
    2. Administrative Staff
    3. Billing Contact
    4. Claim Report CC
    5. Claims Coordinator
    6. Detention Center Contact
    7. Detention Center Staff
    8. Elected Official - Highest Ranking
    9. Emergency Management Contact
    10. Finance
    11. Finance Contact
    12. Health Coop Contact
    13. Human Resources Staff
    14. Human Resources Contact
    15. Information Technology Contact
    16. Legal Contact

    1. Main Contact
    2. Main Contact cc:
    3. Parks and Recreation Contact
    4. Planning and Zoning Contact
    5. Police Contact
    6. Police Staff
    7. Public Entity Sponsor
    8. Public Works Contact
    9. Public Works Staff
    10. Risk Management Contact
    11. Risk Management Staff
    12. Sheriff Contact
    13. Sheriff Staff
    14. Transportation Contact
    15. Utilities Contact
    16. Vehicle Maintenance Contact
31. Additional Information
Leave This Blank:


32. Submit

* indicates a required field