Form Center

Queen Anne's County Community Emergency Response Team (CERT) Training

2. Name (First, Last)*

4. Address1*

6. Address2

8. City*

9. State*

10. Zip*

12. Community Affiliation

14. Email*

16. Phone Number*

18. Next Available CERT Class*

    1. 8/5, 8/7, 8/12, 8/14, 8/19, 8/21, 8/26, 8/28 Class Times: 6 - 9 pm Kent Island Volunteer Fire Department 1610 Main Street, Chester MD 21619

    1. 9/9, 9/11, 9/16, 9/18, 9/23, 9/25, 9/30, 10/2 Class Times: 6 - 9 pm Crumpton Volunteer Fire Department 300 3rd Street, Crumpton MD 21628

    All dates must be attended to complete the training.

Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field