CERT 2012 Survey

We offer CERT training on a regular basis. Please take a moment to submit your contact information to be added to our interest list. As we schedule classes we will contact individuals on the interest list for enrollment in the classes. Please complete the information below in order to be placed on the interest list.

1. Please enter your contact information.

Please enter your contact information. First Name
Last Name
Address:
Address 2:
City/Town:
State:
ZIP:
Country:
Email Address:
Phone Number:

2. I am interested in volunteering with the Anaheim Fire Department.

I am interested in volunteering with the Anaheim Fire Department. Yes

No

Other (please specify)

3. How did you hear about our volunteer opportunities?

How did you hear about our volunteer opportunities? Hi Neighbor

City of Anaheim Website

Utility Bill Message

Brochure

Channel 3 Anaheim Television Channel

Radio/TV/Newspaper

A Friend

Other (please specify)