Emergency Travel Form

This form is to be completed by an authorized representative for the organization. You will assign your Organization Type when completing the form.

For further local guidance and updates please comply with travel directives released in the media and on official Erie County Channels.

Organization Information

Organization Name

Organization Address

Organization Address 2

Organization City/Town

Organization State/Province

Organization ZIP/Postal Code

Organization Authorized Contact

Enter name of authorized organization representative

Authorized Contact Phone

Authorized Contact Email

Confirm email address of authorized contact

Organization Type

Please select

Describe Essential Task(s)

Please enter essential duties