ULM Campus 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.

Question Title

* 1. Please provide First Name and Last Name

Question Title

* 2. Address

Question Title

* 3. Phone Number 

Question Title

* 4. Email Address

Question Title

* 5. Agency/Group/Organization/Department Name:

Question Title

* 6. Have you completed a Basic CERT course?

Question Title

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

Question Title

* 8. Do you require special accommodations for participation? Please explain:

Question Title

* 9. Do you have any food allergies or dietary restrictions? Please explain:

Question Title

* 10. The Office of the Lieutenant Governor maintains a list of citizens interested in supporting volunteer efforts in the wake of a disaster across Louisiana.                                                                      Would you like to be added to this group?

Question Title

* 11. I would like to receive the Volunteer Louisiana quarterly newsletter.

Question Title

* 12. T-shirt size

Question Title

* 13. Additional Comments:

T