Community Emergency Response Team (CERT), Part 1 Training Registration, 9/7/19

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 in the generation of completion certificates.

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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. Agency/Organization Represented

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

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* 8. Please list any/all additional CERT team trainings or certifications received.

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