Program Signup

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Program Signup

Thank you for your interest in the Coastside CERT program. By filling out the form below, you agree to receive emails from us about this program. We will not share your information with any individual or organization.

IMPORTANT NOTE: When you click the Submit button, you may need to scroll up to see the Google popup screen that will verify you are a person and not a robot.

Email *

Given/First Name *

Family/Last Name *

Physical Address (alternatively, select Coastside Neighborhood in next question)

Coastside Neighborhood *

Phone Number (not required but recommended)

Are you a CERT? *

Yes

Would you like to attend CERT training? *

Yes

Are you a ham radio operator? *

Yes

Would you like to become a ham radio operator? (Often the only reliable method of communication in a disaster.) *

Yes

A copy of your responses will be emailed to the address you provided.

Submit

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