Picfair Village Disaster Emergency Preparedness Team (DEPT) - Registration
Email address *
First and Last Name *
Your answer
Street # (just the number) *
For example, if you live or work at 1654 Spaulding, enter only '1654' in the line below
Your answer
Street Name *
Cell Phone # *
Your answer
Home Phone # (if applicable)
Your answer
Best way(s) to reach you during non-disaster times (for planning purposes) *
Keep in mind that during a disaster/emergency, we may not have a choice!
Required
When are you usually in the neighborhood? *
Required
Preferred Role(s) with the Picfair Village Disaster Emergency Preparedness Team: *
Please select only the role or roles you are qualified to fill.
Required
***Relevant Training, Skills and Experience***
Please include any additional information below
Are you trained in any of the following?
Are you are Certified Medical Professional? *
Required
If you are, please describe what you do below.
Your answer
Do you have any other skills, experience or items that might be helpful in a disaster, or in planning for one, such as:
If you have any questions about this effort, please type them below.
Your answer
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