Registration: Gulf Coast Project

This is an explanation of the purpose of the form ...

  1. Please provide the following contact information:

    First Name
    Last Name
    Middle Initial
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Work Phone
    Home Phone
    FAX
    E-mail

  2. Please identify and describe yourself:

    Date of Birth
    Sex Male Female

  3. Select any of the following Disaster Relief Training in which you have been certified:

    Introduction to Disaster Relief
    Blue Cap
    Chain Saw Operation and Safety
    Chaplain
    Childcare
    Communications
    Crew Chief
    Damage Assessment
    Flood Recovery (Mudout)
    Forklift Operation and Safety
    Laundry
    Mass Feeding
    Rebuild
    Service and Delivery

  4. Select any of the following construction skills that you possess:

    What's a hammer?
    I am a carpenter by trade
    I am a plummer by trade
    I am an electrician by trade
    General framing
    Truss installation
    Roofing installation
    Window and door installation
    Siding installation
    Sheetrock (mud and tape) installation
    Flooring installation
    Painting
    Proficient with a skill saw
    Basic plumbing (sink, tub, etc)
    Basic wiring (hang lights, install switches, etc.)

  5. Do you have any special tools (ie. generators, metal brakes, etc.) that might be useful for this trip?


  6. Have you ever participated in a disaster relief project?

    Yes No

Author information goes here.
Copyright © 1999 [OrganizationName]. All rights reserved.
Revised: 12/31/06