Contact Update Form

ERMA Contact Update Form

This form allows you to update your Employee Protection Line (EPL), Training & Human Resources, and Finance contacts. If you have any questions or concerns, please email [email protected].

JPA(Required)

Agency(Required)

Agency Address(Required)

Street Address Address Line 2 City ZIP Code

Removing a Current Contact

Please provide the name of the existing contact you wish to remove. Please note, if you would like to replace this contact, please complete the 'New Contact Information' section below.

Name

First Last

New Contact Information

Please use this section to provide the details of any contacts you wish to add.

Name

First Last

Title

Email

Address (if different from 'Agency Address' above)

Phone Number

Would this contact like to receive ERMA Training Bulletins?(Required)

Yes

No

Type of contact (select all that apply)(Required)

Employee Protection Line (EPL)

Human Resources & Training Contact

Finance Contact

Do you need to add additional contacts?

Yes

No

Additional Contacts

Name

First Last

Title

Email

Address (if different from 'Agency Address' above)

Phone Number

Would this contact like to receive ERMA Training Bulletins?(Required)

Yes

No

Type of contact (select all that apply)(Required)

Employee Protection Line (EPL)

Human Resources & Training Contact

Finance Contact

Additional Comments

Please use this space to leave additional comments for ERMA staff.

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