RUASI Private Sector Registration

Benefits to Registration

• Training Announcements
• Ability to Request On-Site Training for Your Organization
• Access to Training History
• Bulletins and Pass Throughs
  
  

CONTACT INFORMATION
First Name:  *

Last Name: *

Position/Title/Rank:  *

Phone Work: (###-###-#### - ext) *

Mobile Phone: (###-###-####)

Email Address:  *
Use organization email address.

Please re-type your email address: *

Address: *

Address 2:

City: *

County: *
-Select County-RiversideSan BernardinoOther

State:*

Zip code:*

ORGANIZATION NAME
Company/Organization Name:  *


AFFILIATIONS
Are you registered with JRIC? *
Yes  No 
Are you a TLO *
Yes  No 

SUPERVISOR INFORMATION CONTACT
Full Name: *

Supervisor's Title: *

Phone Work: * (###-###-####)

Supervisor's Email Address: *
(Organization email addresses only)


WEBSITE ACCESS
Create a password for site access.
(min 8 characters; 1 numeric, 1 special)
Password: *

DESCRIPTION OF FACILITY OR NATURE OF BUSINESS
* Description is required to substantiate the need for inclusion in the RUASI

*Required  Select "Other" if not applicable