New Jersey Emergency Preparedness Association

Volunteer Sign-Up Form

First Name:

Middle Initial:

Last Name:

Address:

Line 2:

City:

State:

Zip Code:

County:

Home Phone:

Work Phone:

Email:

Confirm Email:

Are you a member of a CERT Team? Yes No

Name of CERT Team:

Other Agency Name:

Please check all sessions that you would be available to volunteer. You will be notified of the actual date(s) and time(s) that your help will be needed. Note any other information that would be helpful below.

	Mon. 5/5	Tues. 5/6	Wed. 5/7	Thurs. 5/8	Fri. 5/9
AM (7-12)
PM (12-5)

Other Info: