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2. Community Emergency Response Team (CERT) Registration Form
   This form applies to one person only. For additional participants, please submit this form and repeat the process. For question or concerns, contact cert.tomball@tomballtx.gov
4. First Name*
5. Last Name*
7. Email Address*
9. Cell Phone Number*
11. Sign Me Up for the CPR Course

    1. Yes
    2. No
13. List any special accommodations you may need:
15. *Note – All information entered here is forwarded to the CERT Coordinator. The City of Tomball does not store or accumulate this data.
Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field