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CERT Participant Application

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City of Tigard
Community Emergency Response Team
�Partners Being Prepared�
Participant Application

Tigard�s Community Emergency Response Team (CERT) program is free to anyone who lives or works in Tigard. The city�s CERT membership welcomes professionals from any of Tigard�s large corporations, small business owners, Tigard High School students, Explorer Scouts, Ham Radio groups, Neighborhood Associations, and any of our 44,000 concerned residents to get certified by successfully completing an eight week, 24 hour program. You must be 18 years old or older to attend, but 16 year olds may attend if accompanied by an adult.

Important Note: All participants must have a criminal background check prior to becoming a CERT member.

Name		* required field
First Name *	MI	Last Name *
Physical Address
Street Address *
City *	State *	Zip *
Mailing Address
Check if Mailing Address is the same as Physical Address
Street Address *
City *	State *	Zip *

Contact Information
Home Phone *	Work Phone	Cell Phone
Email *

Which Class Are You Registering For?
Spring 2009 or Fall 2009*