ALGIM Collaborative Initiative: Virtual Information Security Consultant (VISC) Sign up form

ALGIM Collaborative Initiative: Virtual Information Security Consultant (VISC)

SIGN UP FORM
Information you enter into this form will be received by both ALGIM and SSS, for the purposes of administering the ALGIM Collaborative Initiative - Virtual Information Security Consultant. Contact details will also be used to provide you with information about ALGIM offerings and events we believe to be relevant to your council's interests.
Council Name/ CCO *
Contact name *

First Name Last Name
Contact job title *
Contact's department/business unit *
Contact phone *

Area Code Phone Number
Contact email *
name@council/CCO.govt.nz
Council physical mailing address *

Street Address

Street Address Line 2

City/Town Region

Postal Code
Purchase order number (Please make the PO out to SSS) *
Primary user details

This is the person who will be responsible for your site. They may be different from the contact person.
The primary user will be: *

The contact person Someone different
Primary user's name *

First Name Last Name
Primary user's email *
name@council/CCO@govt.nz
Primary user's job title *
Primary user's department/business unit *
I certify that I have the authority to sign my council up to the ALGIM Collaborative Initiative - Virtual Information Security Consultant. *

Yes
Should be Empty:

ALGIM Collaborative Initiative: Virtual Information Security Consultant (VISC)