Fullerton Website
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Fullerton Fire Department
City of Fullerton
Fullerton Fire Department
CERT Registration
Name
*Required
Email
*Required
Address
*Required
City
*
Zip
*Required
Phone
*Required
Cell Phone
Please tell us briefly why you are interested in the CERT Program
Please list any previous training in emergency preparedness, first aid and/or safety you have participated in (previous training is
not
required)
Course Title
Date Completed
mm\dd\yyyy
mm\dd\yyyy
mm\dd\yyyy
Please list any previous experience in emergency preparedness and/or emergency response you have had (previous experience is
not
required)
How did you find out about our CERT Program? (Please check all that apply)
City of Fullerton Website
Fullerton Observer
Friend/Neighbor/Co-worker
Newspaper
(name of paper)
Other