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CPH Information Technology Support Services
2-Way Radio Request Form
Building Services – Radio Request Form
Full Name
*
Division
*
Addiction Services
Clinical Health
CPHI
Environmental Health
Family Health
HCO Admin (Comm, DME, EAP, HR)
Neighborhood Social Services
Population Health
Sexual Health Promotions
Support Services
Program Name
*
Location/Room #
*
Contact Number
*
Email
*
Event Information
Event Name
*
Event Start Date
*
Event End Date
*
Event Location
*
Number of radios requested
*
Are headsets needed?
*
Yes
No
Are multichargers needed?
*
Yes
No
Submit
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