2. Contact Name
3. Community Name
5. Address
7. City
8. State
9. Zip
11. Are you a full time Tamarac resident?

    1. Yes

    1. No
12. Email Address
14. Phone Number
15. Alt. Phone Number
17. CERT Program Materials
    The City of Tamarac's CERT Program is attempting to cut down on printing costs in our effort to 'Go Green'! Please include your email address above so that we may send you an electronic book copy and additional information. If you do not have access to e-mail or a computer, please contact Van Schoen directly (information listed below).
19. Have questions?
    If you have any questions about Tamarac's CERT Program, you may contact the program leader Van Schoen at (954) 597-3805 or by e-mail at Van.Schoen@tamarac.org. Please select "Submit" so we may begin to process your information.
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit Submit and Print

* indicates a required field