APPLICANT INFORMATIONFirst Name:*Last Name:*Position/Title (if applicable)Company / Organization Name:Address:*Address 2:City:*State: (ie: NM)* Zip code:*
ASSOCIATION AFFILIATION(Trade Association Membership Required)Name of your Trade Association* CONTACT INFORMATIONPhone: (include area code)* Mobile Phone: (include area code, no dashes) Mobile Provider: Select your mobile provider...AlltelAT&T WirelessNextelSprint PCST-MobileVerizon WirelessVirgin Mobile Mobile Email Address Fax: (include area code) Email:* Create a Password:* (CICA site access)
CICA is an alliance of Contracting Industry Representatives who work in partnership with law enforcement to address crime that occurs in retail buildings / properties. Upon completion and submittal of this on-line form, your application will be reviewed; upon approval, you will receive notification via e-mail. Access to this secure website enables law enforcement and retail partners to communicate regarding public safety issues that impact the retail sector. The information communicated through this website is for Law Enforcement use only. Any unauthorized release, copying, distribution or posting for any Non-Law Enforcement Use of any of the information provided by this website, will result in the termination of access 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 CICA Website.