The 1998 Local Law Enforcement Block Grant the City of Durham received makes the distribution of these Emergency Beacons possible at no cost. This Grant came from the Bureau of Justice Assistance which is division of The United States Department of Justice. A large portion of the grant money went to purchase the Durham Police Department Mobile Police Station that was placed into service last year. $100,000 of this Grant was divided among each of the four Police District Partnerships Against Crime programs to assist our neighborhoods in combating crime and promote Community Policing efforts within the City of Durham.

These Emergency Beacons function as ordinary light bulbs, but with a quick couple of flicks of the light switch they begin to flash on and off. This ‘flashing beacon’ brings attention to your residence and assists Emergency Personnel in finding you along with alerting your neighbors that there is an emergency at your home.

In order for the Partners Against Crime District II to administer this Grant Program we need your assistance in completing the following information before we can distribute your free Emergency Beacon. At this time we are not offering these Emergency Beacons for sale. The Partners Against Crime District II can provide Emergency Beacon product information to those people who wish to purchase one for their own use.

Your registration information will be used to document that these Emergency Beacons were distributed to residents of District II that have met one of the two basic requirements. To receive a free Beacon you must be over 60 years of age or have a medical or physical disability that would necessitate Emergency Services being able to locate your home should a crisis arise.

The information you provide on this form will not be sold or distributed to any other group or organization and will only be used by the Partnership Against Crime District II organization to assist administer this Grant.

By completing this form and accepting an Emergency Beacon you agree to be contacted in six months and one year from this date to report where the Beacon was installed, was it used to alert Emergency Personnel, or bring attention to your residence and whether it is still in operation. We will need this information to complete the performance indicators and Grant evaluation forms.

We appreciate your participation in this initiative.

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Carefully Print your Full Name______________________________/______________________________

Signature

Birth date/year___________________________

Address______________________________________ Zip code____________________________

Phone number_________________________________ alternate contact______________________

Brief description of medical condition or physical disability