2016 Fairfield Easton Medical Reserve Corps Annual Education Session Registration

The Fairfield Easton Medical Reserve Corps is hosting its Annual Education Session (AES) at the Bigelow Center for Senior Activities (formerly Fairfield Senior Center, 100 Mona Terrace, Fairfield, CT 06824) on Thursday June 2, 2016 from 5:30-7:30pm. The theme of this year's AES is Emerging Infections and Zika Virus.

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* 1. Will you be attending this event?

Yes

No, but I would like to participate in the Zika Prevention Campaign and will come to the Health Department after June 2nd. Please continue with survey.

I will come for Loyalty Oath at 5:50 for free vest, shirt, cap or id lanyard (while supplies last) answer questions 2 and 3 also please.

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* 2. Please fill out your contact information below.

Name

Email Address

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* 3. Who are you representing?

Fairfield Easton Medical Reserve Corps

Fairfield CERT

Other (please specify)

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* 4. I will be signing up for the Zika Prevention Campaign and go door to door placing mosquito borne illness prevention door hangers on homes.

Yes

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* 5. If yes to Question 4, I am willing to distribute door hangers to approximately the following number of homes:

100

150

200

More than 200