ALGIM LG Cybersecurity Programme: Sign up form

ALGIM LG Cybersecurity Programme: Sign up form
Information you enter into this form will be received by both ALGIM and SAM for Compliance, for the purposes of administering the ALGIM Local Government Cybersecurity Programme. Contact details will also be used to provide you with information about ALGIM offerings and events we believe to be relevant to your council's interests.
Please indicate if this is your first time signing up or are you renewing your current agreement?*
Council/CCO*
Council name abbreviation (if used)
Contact name*

First NameLast Name
Contact job title*
Contact's department/business unit*
Contact phone*

Area CodePhone Number
Contact email*
name@council/CCO.govt.nz
Council physical mailing address*

Street Address

Street Address Line 2

City/TownRegion

Postal Code
Purchase order number (Please make the PO out to SAM for Compliance)*
Primary user details

This is the person who will be administrator for your site and manage your users. They may be different from the contact person.
The primary user will be:*

The contact personSomeone different
Primary user's name*

First NameLast Name
Primary user's email*
name@council/CCO@govt.nz
Primary user's job title*
Primary user's department/business unit*
ALGIM LG Cybersecurity Awards
My council agrees to participate in the ALGIM Local Government Cybersecurity Awards*

YesNo
If yes, Council agrees that their data will be used for the purposes of ascertaining achievement with the Award Levels 1, 2 and 3 and Most Improved categories. ALGIM reserves the right to verify the accuracy of the data.
I certify that I have the authority to sign my council up to the ALGIM LG Cybersecurity programme.*

Yes
Should be Empty:

ALGIM LG Cybersecurity Programme: Sign up form

Primary user details

ALGIM LG Cybersecurity Awards