COPIN Membership Form

Membership Application

Complete the form below to sign up to become a COPIN member.
Name *

First Name Last Name
Title *
Agency *
County *
Primary Phone: *

- Area Code Phone Number
Alternate Phone:

- Area Code Phone Number
E-mail *
COPIN Membership Options

Please Choose One
*Response Team Member: By selecting this membership level, I agree to:
- Contribute to COPIN by attending meetings and trainings
- Support COPIN initiatives where I am able.
- Subject to my availiablity and the approval of my agency. I also agree to respond to a COPIN call for emergency PIO assistance to a requesting agency in the event of a major incident or disaster.
*To be considered for Response Team status, you must provide documentation of experience, education, training or certification prior to approval by the Board.
Supporting Member: By selecting this membership level, I agree to:
- Contribute to COPIN by attending meetings and trainings.
- Support COPIN initiatives where I am able.
Select One *

Response Team Member Supporting Member
COPIN Code of Conduct

COPIN members recognize the value of professionalism and genuine helpfulnesses when requested to assist other organizations. As such, each singatory agrees to abide by the following code of conduct:
- I will avoid self-deployment and respond only when requested as a member of COPIN or through assignment from my organization.
- I will accept the assignment I am given.
- I will avoid freelancing and follow the host organization's public information section of the Incident Plan (IAP).
- I will be a positive ambassador of both my participating agency and COPIN.
- I will be considerate of the impact the event has on the host organization, and respect its limitations, its values and its standards.
- I will be a solution to the problem, and provide the highest level of service possible.
- I will get along with other guests of the host organization, and foster career and volunteer cooperation.
- I will maintain self control, discipline and patience.
- I will listen and help quietly.
- I will leave when its' time, and ask if I'm not sure.
Signature *

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Date

- Month - Day Year
Please enter date of when form was filled out and signed.
Upload supporting Response Team Member documents

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To be considered for Response Team status, you must provide documentation of experience, education, training or certification prior to approval by the Board. Cancel of
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Membership Application

COPIN Membership Options