Long Beach CERT - Volunteer Update Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Do you still want to participate in Long Beach CERT?
*
Yes
No
Are you a City of Long Beach employee?
*
Yes
No
Which department do you work for?
*
Do you have an active or previously active license or certification?
*
Yes
No
What type of license or certification do you have?
*
Is your license or certification active?
*
Yes
No
Enter your license/certification number
Will you be looking for volunteer opportunities throughout the year, or only in emergencies?
*
I want to volunteer throughout the year.
I only want to volunteer for emergencies.
Submit
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