CM CERT Application

2. 

3. A City staff member will contact you and answer any questions you have about CERT after submitting this online application.

   A City staff member will contact you and answer any questions you have about CERT after submitting this online application.

5. First Name*

6. Last Name*

8. Email*

9. Primary Phone*

11. Address*

12. City*

14. State*

15. Zip Code*

16. Are You Age 18+?

    1. Yes

    1. No

Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field