New/Updated NC LETR Agency Contact Form

This form should be completed when a NC LETR agency needs to update contact information for its coordinator.

New/Updated NC LETR Agency Contact Form

Date
MM slash DD slash YYYY
Department*
Coordinator Name
First Last
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Shipping Address*
Street Address Address Line 2 City State ZIP Code

Note: Please no P.O. boxes, we need a physical address where UPS can deliver packages.
Phone Number*
Fax Number*
Email*
Name of Chief/Sheriff/Facility Administrator*
First Last
Chief/Sheriff/Facility Administrator Email*
Please select all that apply

If you have any questions about the form, contact the NC Torch Run at (919) 719-7662.