Lowcountry CERT Membership Application

Evacuation Zone:

-- A B C D E F G H I

Please select what county you report to:

Berkeley
Charleston
Dorchester
Other

If "Other", state what county you report to:

This information will help us locate you in the event of a disaster. If you feel you don't have the information contact your County advisor or please leave blank.

Please fill out all of the fields:

Your Full Name*:

Full Address (including Zip Code)*:

Home Phone Number*:

Work Phone Number:

Cell Phone Number:

Email:

Please contact me by:

Home Phone
Work Phone
Cell Phone
Email

County CERT Training Completed

Yes
No

If training complete, pick date:

ICS Training Completed

Yes
No

If training complete, pick date:

If you have completed all your requirements and have graduated the County CERT course you are an active Member of Lowcountry CERT for the year you graduated. Continuing Education begins after.