Welcome to Berkeley CERT's 2013 City Emergency Exercise Official Registration Form. Please complete your registration to receive important exercise date activity updates and pre-drill tips and information. You will be joining thousands of other Berkeley community members in preparing for emergency and disaster.
First Name

Question Title

* 1. First Name

Last Name

Question Title

* 2. Last Name

Email Address

Question Title

* 3. Email Address

Phone Number

Question Title

* 4. Phone Number

Please Enter Your Street Address (Eg. 997 Cedar St.)

Question Title

* 5. Please Enter Your Street Address (Eg. 997 Cedar St.)

Zip Code

Question Title

* 6. Zip Code

I am registering as a (choose all that apply)

Question Title

* 7. I am registering as a (choose all that apply)

I have registered for the Berkeley Emergency Notification System to receive the test message on April 27 (For detail see participant handbook and visit http://www.ci.berkeley.ca.us/BENS)

Question Title

* 8. I have registered for the Berkeley Emergency Notification System to receive the test message on April 27 (For detail see participant handbook and visit http://www.ci.berkeley.ca.us/BENS)

If interested in volunteer opportunities with Berkeley CERT, check the box below; (Make sure you provided your email address in box 3.)

Question Title

* 9. If interested in volunteer opportunities with Berkeley CERT, check the box below; (Make sure you provided your email address in box 3.)

How did you hear about the exercise?

Question Title

* 10. How did you hear about the exercise?

Almost Done....Last Step: Click Done and thank you for completing your registration! Be sure to download the Participant Handbook from the main exercise webpage to get started on selecting and planning your exercise activities!

T