Member Representation Request Form Member Representation Request Form Member Representation Name * Name First First Last Last Phone * Email * Are you an Active Member? * Yes No Are you Witness or Subject? * Witness Subject EID # * EID # (if applicable) Station / Shift or N/A? * Rank * Assignment * Case Number (CTS or COM) Request a Specific Rep? Summary of your request Submit If you are human, leave this field blank.
