DVIC Phila
Serving:   PA – Bucks ● Chester ● Delaware ● Montgomery ● Philadelphia 
DE – New Castle ● MD – Cecil ● NJ – Burlington ● Camden ● Cumberland ● Gloucester ● Salem

Public Safety, Government, Private Sector Registration

Notification e-mail address must be company / organization affiliated. Please, no personal e-mail addresses. Please complete the form below, no partial applications accepted.

CONTACT INFORMATION
First Name  *

Last Name *

Position/Title/Rank:  *

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

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

Email Address:  *
Use your company/organization address

Please re-type your email address: *

Address: *

Address 2:

City: *

County: *

State:*
 Zip code:*
 
 

AGENCY / ORGANIZATION
Agency/Organization Name:  *


SUPERVISOR CONTACT
Full Name*

Supervisor's Title*

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

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


WEBSITE ACCESS
Password: *
Create a password for site access / 
modify your contact information

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

*Required  Select "Other" if not applicable

Food and Agriculture
Financial Services
Commercial Facilities
Chemical
Communications
Critical Manufacturing		 Dams
Defense Industrial Base
Emergency Services
Energy
Healthcare And Public Health
Government Facilities		 Information Technology
Nuclear Reactors Materials and Waste
Transportation Systems
Water and Wastewater Systems

Other Sector (please specify)

 

All registration information is considered strictly confidential and will not be shared.

 

I agree to the following terms and conditions:

NON-DISCLOSURE AGREEMENT

Intending to be legally bound, I hereby accept the obligation contained in this Agreement in consideration of my being granted access to “sensitive information.” The term, “sensitive information” may include:

For Official Use Only (FOUO): information which warrants a degree of protection and administrative control that meets the criteria for exemption from public disclosure under the Privacy Act, and state and federal Freedom of Information Acts.

  1. I agree to keep confidential all “sensitive information” provided by the Delaware Valley Intelligence Center (DVIC) and to protect its confidentiality and restrict its access based on a right and need to know. “Sensitive information” disseminated by the DVIC shall not be disseminated by the recipient without permission from the DVIC and shall only be disseminated via official government e-mail. It shall not be disseminated via commercial ISP or webmail services, i.e. Yahoo or Gmail or ​posted to online platforms.
  2. I understand that the unauthorized disclosure of “sensitive information” by me could cause damage or irreparable injury to future or ongoing investigations and operations. I understand that I am obligated to comply with the DVIC standard operating procedures regarding the authorized disclosure of such information.
  3. I hereby assign to the DVIC all royalties, remunerations, and emoluments that have resulted, will result, or may result from any disclosure, publication, or revelation of “sensitive information” not consistent with the terms of this Agreement.
  4. I understand the Delaware Valley Intelligence Center (DVIC) may seek any remedy available to enforce this Agreement. Actions may include the termination of access to DVIC information, criminal prosecution, and/or the application of a court order prohibiting disclosure of “sensitive information” in breach of this Agreement. I hereby waive any and all rights that I may have to object to the issuance of any such order.
  5. I understand that all “sensitive information” to which I have access or may obtain access by signing this Agreement is now and will remain the property of, or under the control of, the DVIC unless and until otherwise determined by an authorized official or final ruling of a court of law.
  6. I hereby acknowledge that I have read this Agreement in full concerning the nature and protection of “sensitive information.” This signed agreement shall be kept on file with the DVIC until no longer required.