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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. Currently there is no upcoming class scheduled. Select this box to be added to the waiting list. You will be updated as soon as a class is scheduled.

    All dates must be attended to complete the training.

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

    This field is not part of the form submission.

22. Submit

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