District of Columbia’s Business Emergency Operations Center

Please complete and submit the following form to apply for participation in the District of Columbia’s Business Emergency Operations Center (“BEMOC”).

*indicates required field.

I. Application Information
A. Primary Point-of-Contact
B. Alternate Point-of-Contact
C. Business Address
*(Physical Address Required. No P.O. Boxes)
D. Business Description
E. Sector/Subsector
Please Describe Your Business
II. Membership Responsibilities
II. MEMBERSHIP RESPONSIBILITIES A. Applicant may receive information that is sensitive and not publicly available ("Protected Information"). Protected Information may be provided by or through the District of Columbia government, the US government or other private sector members. Applicant understands and agrees to the following terms regarding Protected Information. 1. Participation is Voluntary: Applicant is not obligated as a condition of BEMOC participation to disclose any information to the BEMOC, HSEMA, Federal agency, or other partner or member. 2. Confidentiality and Non-Disclosure: Protected Information is to be regarded as Business Confidential and shall not be disclosed beyond its intended scope. 3. No Guarantee of Fitness: Protected Information is provided as a service to BEMOC participants and may be unevaluated and unverified. As such, Protected Information is not guaranteed to be accurate, complete, or actionable. 4. Submission in Good Faith: Applicant agrees that he/she will not submit information which he/she knew at the time of submission to be false, and that he/she will submit information only to further BEMOC’s stated purposes. B. Applicant understands and agrees that the BEMOC is not to be commercially exploited as a forum to market products or services and that doing so may result in the revocation of Applicant's participation in the BEMOC. C. Applicant agrees to act in a manner consistent with District of Columbia law, regulation or other requirements of HSEMA or the U.S. Government. D. Applicant understands and agrees that participation is voluntary and does not explicitly or implicitly imply a legal relationship between HSEMA and the Applicant. III. APPLICANT REQUIREMENTS A. At least 18 years of age on the date of completion of this Application. B. Is the owner; chief operating officer; senior manager; or employee that has obligation authority of a company or non-profit organization doing business in the District of Columbia. C. Consents to periodic re-confirmation of participation requirements. D. Agrees to and completes this Application Form. E. Any further requirements mandated by HSEMA or the BEMOC. IV. PRIVACY ACT STATEMENT Principal Purpose and Routine Uses: The information collected on this form will be used to assist in determining approval, denial, revocation or renewal of access to the BEMOC web site and the authorization to receive BEMOC protected information. Information provided by the applicant will be protected and used in strict compliance with the District of Columbia’s privacy law. V. CONSENT To the best of my knowledge and belief, I affirm that a). I meet all of the requirements to be a BEMOC participant and b). The information I have provided herein is true, complete and correct. I have read, understand and agree with the above information.
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