Paid Registration Winter 2021

Winter 2021 Class Registration Form

You are about to register for a CERT Basic Training series. You will be taken to a Credit Card Checkout screen after completing this form to submit the non-refundable registration fee. Your credit card statement will show "LMOCERT".

9 week basic training class

Provide first name.
Last Nmae
What do we call you? For instance, Elizabeth, Liz or Betty.

What do we call you? For instance, Elizabeth, Liz or Betty.

Home phone with area code. Include dashes. Do not enter your cell phone number, please.

Only digits.

Cell number with area code.

Work phone with area code and extension. Do not enter your cell phone number, please.

Street Address, not PO BOX

ZIP or ZIP+4 code

If you have a GMRS radio license for your household, enter your Call Sign.

If you have a HAM radio license, enter your Call Sign

Lamorinda CERT will make accommodation for all people with Access and Functional Needs. Please give us a brief summary of anything you need to make the class series work for you. We will do our best to accommodate you.