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2. First Name*
3. Last Name*
5. Department*
   -- Select One --EMSEMASheriffBenton PDEl Dorado PDLeon PDRose Hill PDFD1FD2FD3FD4FD5FD6FD7FD8FD9FD10Atlanta FDEl Dorado FDPotwin FDTowanda FDOther

   The Department CAD will affiliate you with
6. Your Radio Number*
   What (handle) do people call you on the radio?
8. Your Text capable cell phone number
   Butler County is NOT responsible for data charges. If you have a limited data plan charges may apply.
9. Cell Phone Provider
   such as Verizon, AT&T, etc.
11. Do you have a preferred SMS email address?

    1. Yes
    2. No
12. Preferred SMS email address
14. Your email address
    Leave blank if you do not wish to receive emails from CAD
15. Update Existing CAD profile?*

    1. New CAD notify request
    2. Update my existing information
    3. Delete my existing information

    If you no longer wish to receive text messages or emails from CAD please select the Delete option.
17. Comments
19. App for Androids
    
Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field