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2. Submit Volunteer Time

   Did you participate in an event, attend a class or exercise, provide community education, or first aid coverage? 

   We need to track each individuals time when participating in any CERT activity. To ensure our records are accurate, we ask that each time you participate in any CERT activity, submit you time using the form below. 

   Let us know what you have done and help us communicate the value of your service.

4. CONTACT INFORMATION
6. First Name*
7. Last Name*
8. CERT ID*
10. Address
12. City
13. State
14. Zip Code
16. Email*
17. Phone Number
19. ACTIVITY INFORMATION
21. Date*
    Date
22. Start Time*
    -- Select One ---07000730080008300900093010001030110011301200123013001330140014301500153016001630170017301800183019001930200020302100213022002230230023300000003001000130020002300300033004300500053006000630
23. End Time*
    -- Select One ---07000730080008300900093010001030110011301200123013001330140014301500153016001630170017301800183019001930200020302100213022002230230023300000003001000130020002300300033004300500053006000630
25. Activity Type*
    -- Select One --Attend ClassAttend EventCommunity Event SupportFirst Aid SupportInstructorEmergency ResponsePublic ServiceAdminOther
27. Description
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field