Summit CERT database
Thank you for taking time to complete this Summit CERT survey. The survey has two paths, one for those interested in getting started and one for those that already have some training (CERT, Ham Radio, First Aid, etc.).
Email address *
LAST NAME *
Your answer
FIRST NAME *
Your answer
HOME ADDRESS *
Number and street only
Your answer
HOME ZIP CODE *
Your answer
MAILING ADDRESS
Only if different from above address
Your answer
MAILING ZIP CODE
Your answer
HOME PHONE *
Include area code (XXX-XXX-XXXX)
Your answer
CELL PHONE *
Include area code (XXX-XXX-XXXX)
Your answer
EMAIL # 1 *
Your answer
EMAIL # 2
Your answer
Describe yourself *
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