Local Privacy Officer Group Sign-Up Form

The Network for Public Health Law Local Privacy Officer Peer Group brings together privacy officers from city, county, and other local government to provide peer support and resources. Members participate in quarterly webinars and on a Local Privacy Officer listserv, where members can share experiences and resources. Members are also included in a membership directory, which is shared with other members. Please complete the form below to be included in the Local Privacy Officer Peer Group, its listserv and its directory. Once your membership to the group has been approved, you will receive a welcome email with additional details, including how to communicate with the listserv.
1.Jurisdiction (e.g., Cook County or Milwaukee)
2.First name
3.Last name
4.Degrees and/or credentials (e.g. JD, CIPP)
5.Title
6.Email
7.Telephone No.
8.Telephone Ext.
9.Fax
10.Street address(Required.)
11.City(Required.)
12.State(Required.)
13.ZIP Code(Required.)
14.Are you interested in serving in a chair or committee role?
15.What topics would you like to see covered in a future webinar/resource?