La Verne CERT Course #0920 Enrollment
Please complete this form to enroll in La Verne CERT Course #0920, February 10 - March 7, 2020.
NOTE: A valid email address is REQUIRED to confirm enrollment and provide necessary communications throughout the course.
Please provide your full name as Last name, First Name.
Please include #, street, city, and zip code.
Please include area code (xxx-xxx-xxxx)
I live in...
Multi-family Residence (apartment, condo, duplex, townhome)
Mobile Home Park / Senior Living Community
How did you learn about us?
La Verne Community News
Flyer or brochure in town
La Verne CERT Website
Word of Mouth
Send me a copy of my responses.
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