Thank you for taking a moment to complete this survey. Rather than just offer a CERT or CERT Train the Trainer course in a location of our choice and hope that it will be a "go" - by tracking who needs which classes and where the people are located within the Commonwealth, we can do a better job to offer the right class, to the right people, in the right location. Each individual from your locality who needs either a CERT basic 20.5 course or CERT Train the Trainer needs to complete this survey. If you have any questions, please contact

* 1. Title

* 2. What is your first name?

* 3. What is your last name?

* 4. What is your title or position?

* 5. With what group, local organization or business are you affiliated?

* 6. What locality do you represent? (city/town/county)

* 7. At what email address would you like to be contacted?

* 8. What is the best phone number to reach you by? Please include area code.

* 9. Please select which of the VDEM CERT class(es) you are interested in taking.