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CERT Registration Form
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If you would like to register for an upcoming CERT training class, please complete and submit this registration form.
Contact Information
First Name:
*
Last Name:
*
Address:
*
City:
*
State:
*
Zip Code:
*
Phone Number:
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Email Address:
Registration Information
Please indicate which session you would like to register for:
*
By submitting this form, I agree to participate in the 23-hour Los Gatos/Monte Sereno Community Emergency Response Team (CERT) Training Course. I understand that only those who attend all classroom sessions and the hands on training exercise will receive a graduation certificate and a CERT vest and hard hat. I understand the cost for this 23-hour program is $30 per person for residents of incorporated Los Gatos and Monte Sereno, and $50 for residents of other cities and unincorporated areas of Santa Clara and Santa Cruz Counties.
*
Yes
No
For more information about the CERT program, please call the CERT Office at (408) 399-5722.
* indicates required fields.
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