Tue, 07 February, 2012

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Lakeside CERT Member Contact Information Form

The Lakeside and San Diego County CERT programs are growing. New information and opportunities are made available regularly. It is important for us to have your most current contact information in order to keep you informed. Also, in the event of a disaster it is vital that we are able to contact you for an official CERT activation or a welfare check.

Please fill out and submit this form. Upon submission, you will be sent a confirmation e-mail.

Back to Lakeside CERT page



All fields required

First Name:

Last Name:

Home Phone: (555-555-5555) 

Mobile Phone: (555-555-5555) 

Street or P.O. Box:

City:

Zip Code:

Email Address:





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