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Emergency Management Contact Form

2. Contact Us
   Please use this form to contact the emergency management staff.

   Please use this form to contact the emergency management staff.

4. First Name

5. Last Name

7. Email Address*

9. Home Phone Number

10. Cell Phone Number

12. Residency*
    -- Select One --Outside County, but within MIOutside MIBainbridge TownshipBaroda TownshipBaroda VillageBerrien TownshipBertrand TownshipBenton TownshipMillburgBenton Harbor CityBuchanan TownshipBuchanan CityChikaming TownshipSawyerHarbertLakesideUnion PierColoma TownshipColoma CityGalien TownshipGalien VillageHagar TownshipRiversideLake TownshipBridgmanLincoln TownshipStevensvilleNew Buffalo TownshipNew Buffalo CityGrand BeachMichianaNiles TownshipNiles CityOronoko TownshipBerrien Springs VillagePipestone TownshipEau Claire VillageSaint Joseph TownshipSaint Joseph CityShoreham VillageSodus TownshipThree Oaks TownshipThree Oaks VillageWatervliet TownshipWatervliet CityWeesaw TownshipNew Troy

14. Message*

    Type your message here.

16. Return Contact Preference*

    Indicate all that you prefer to be contacted back via.

    1. Email
    2. Home Phone
    3. Cell Phone
    4. No reply needed
17. Available Times*

    Indicate the best times of day to return your call (if phone is preferred).

    1. 9 AM to 12 PM
    2. 12PM to 1PM
    3. 1 PM to 4 PM
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field