Albuquerque - CONNECT™ 
North I-25 Registration
North I-25 is a partnership between
the Albuquerque Police Department and business along the North I-25 corridor
to address public safety issues which impact Albuquerque's community.
You should only register if you are a North I-25 Partner
or if you have  been referred by an existing partner

APPLICANT INFORMATION
First Name:*

Last Name:*

Position/Title (if applicable)

Company / Organization Name:

Address:*

Address 2:

City:*
State: (ie: NM)* 
   Zip code:*
  

CONTACT INFORMATION
Phone: (include area code)*

Mobile Phone: (include area code, no dashes)

Mobile Provider:

Mobile Email Address

Fax: (include area code)

E-mail:*
 
Password:* (NorthI25 site access)


Are you a member of:
(CMIP - Comanche-Menaul  Industrial Properties)
 Yes  No

ADDITIONAL COMMENTS / REFERRED BY

In an effort to improve communication and assist Law Enforcement in identifying these individuals,
there is the availability of a secure website where local retailers and businesses will be able to post
and review information of a confidential nature to assist Law Enforcement in identifying said individuals.

The information contained on the web site is for Law Enforcement use only.  Any unauthorized release,
copying, distribution or posting for any Non-Law Enforcement Use of any of the information contained
herein will result in the termination of access to this site and may expose an individual or corporation
to legal liability.

I understand the above stated guidelines and will abide by them.  I understand that information on
the website can be removed at the webmasters discretion at any time.  I also understand and agree
that failure on my behalf to abide by the information above will be grounds for dismissal from further
interaction with the Website.
I agree

___________________________________________________________
Signature


After you click "Submit Registration", a window will appear enabling you to print your registration.
Please sign and return this form at the next NorthI25 meeting.
Questions? email