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Eastern Nebraska CERT
Community Emergency Response Team
Please complete the following form to register for a CERT Basic 20 hour class. All students must be at least
eighteen years of age to participate in these classes. Preregistration  is required to attend a class.

          
            First Name    Middle Initial    Last Name
            Address    
            City               State    Zip Code
            Email        
            Home Telephone      Cell Telephone
Work Telephone

Attendance at all sessions are required. Please select from the following list of classes:



Please list any special needs you may have so we can better accommodate your learning experience.



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