REQUEST FOR eLOMA ACCESS TO THE MIP 

Please save your form to your hard drive and submit directly to MIP help at 
“miphelp@riskmapcds.com” 


If you cannot email your form, then find your region on the next page and submit your request 
to the appropriate eLOMA Coordinator. 

All requests will be reviewed by an eLOMA Coordinator. If the request is approved the applicant 
will receive confirmation and set-up information in an e-mail. 

* The asterisks denote required fields. 

New User

Modify Current User 

*Company Name: 

*Last Name: 

*First Name: 

Middle Initial: 

*Street Address, City, State, and Zip Code:
 
*E-mail Address: 

* Phone: 
 
Cell Phone: 

*License Information 
License Number 
License Type (Engineer or Surveyor) 
State Expiration Date (MM/DD/YYYY) 

Enter the license number, type, and state expiration date for each licensed professional


Please save your form to your hard drive and submit directly to MIP help at 
“miphelp@riskmapcds.com” 

If you cannot email your form, then please find your region on the next page and 
submit your request to the appropriate eLOMA Coordinator. 


eLOMA Coordinators by Region: 

Region 2 (New Jersey, New York, Puerto Rico, and the Virgin Islands) 
Region 3 (Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia) 
Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas) 

Please submit your request to: 

Jonathon Foster, CFM 
8401 Arlington Blvd, Fairfax, VA, 22031-2666 
Fax: 800-684-6860 


Region 1 (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) 
Region 5 (Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin) 
Region 7 (Iowa, Kansas, Missouri, and Nebraska) 
Region 10 (Alaska, Idaho, Oregon, and Washington) 

Please submit your request to: 

Keith Loudin 
12101 Indian Creek Court, Beltsville, MD 20705 
Fax: 301-210-4539 


Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and 
Tennessee) 
Region 8 (Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming) 
Region 9 (Arizona, California, Hawaii, Nevada, American Samoa, Guam, Commonwealth of the Northern 
Mariana Islands, Republic of the Marshall Islands, and the Federated States of Micronesia) 

Please submit your request to: 

David Mummert, CFM 
3601 Eisenhower Avenue, Alexandria, VA 22304 
Fax: 703-751-7415