Iberia Parish CERT Training (2 Days)

Please answer the following questions to confirm your enrollment to attend. This information will be used for documentation of those participating in the Community Emergency Response Team (CERT) training and for the generation of completion certificates. Registration is subject to approval.

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* 1. Name (First and Last)

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* 2. Address

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* 3. Phone Number 1

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* 4. Phone Number 2 (optional)

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* 5. Email Address

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* 6. Have you completed a Basic CERT course? Yes or No - and if Yes, enter the location and year completed.

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* 7. Please provide your age range (for data collection only)

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* 8. Do you have any food allergies or dietary restrictions? Explain...

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* 9. Additional Comments:

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