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 *
LAST NAME *
FIRST NAME *
HOME ADDRESS *
Number and street only
HOME ZIP CODE *
MAILING ADDRESS
Only if different from above address
MAILING ZIP CODE
HOME PHONE *
Include area code (XXX-XXX-XXXX)
CELL PHONE *
Include area code (XXX-XXX-XXXX)
EMAIL # 1 *
EMAIL # 2
Describe yourself *
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