Navarre CERT Application
If you are interested in joining Navarre CERT, please complete the information below and submit the form.
Name
Address
City, State, ZIP
Phone number(s)
e-mail address:
Occupation/Profession
Have you had any type of first responder training in the past?
Yes
No
If Yes, what type and when?
Military Experience
Veteran
On Active Duty
Specialty
Medical Experience
Doctor
Nurse
Veterinarian
PA
Gender
Male
Female
Age Group
18-24
25-50
50-65
over 65
Background/Skills/Interests:
Amateur Radio -- Call sign
Computers - What areas?
Graphic Art
Public Speaking
Teaching
Construction
Administrative
Fiscal
Logistics/Resource Planning
Comm Planning/Amateur Radio
Media
Contingency Planning
Disaster Preparedness
Disaster Response
Disaster Recovery
Disaster Mitigation
First Aid
CPR Certified
Fire Safety
Water Safety
Crime Prevention/Law Enforcement
Traffic Safety
Search and Rescue
Chain Saw Operation
Bobcat/Backhoe Operation
Hazmat
Other
Languages spoken (other than English)
Once trained, would you be interested in facilitating training classes?
Yes
No
When could you begin volunteering?
Do you have any questions or comments?
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