Wilton Community Emergency Response Team (CERT) Training / 2005

I would like to register for the six-session CERT training and would like to attend:
⌉ Spring (March) 2005	⌉ Fall (October) 2005
⌉ I am unable to attend the training this year, but please contact me about future CERT training.

Please Print Clearly:

Name:

Street Address:

City:     State:     Zip:

Nearest cross street to your home address:

Telephone (Day):     (Evening):     (Cell):

E-mail to receive CERT information:

Please mail this form (one registration per form, please) to:

Wilton CERT c/o Wilton Town Hall 238 Danbury Rd. Wilton, CT 06897

For more information about the Wilton CERT program, please call any of the following:

Chris Gardner 762-9678 Colleen O'Brien 762-7844 Dick Ziegler 761-1386