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2. To register, please fill out and submit the following form.

   Be sure to include your email address as additional information will be emailed to you prior to the event.

4. First Name
5. Last Name
7. Address
9. City
10. State
11. Zip Code
13. Participating in the Exercise? Type in Exercise
15. Volunteering as a Victim Only? Type in Victim
17. Phone Number
19. Email Address
21. Already Trained? Specify Whether Your Are CERT or MRC Trained

    Also list any other skills you have that may be helpful

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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field