Arizona ShakeOut - Register for the 2013 Arizona ShakeOut

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Register for the 2013 Arizona ShakeOut

Category

Participants

Number of people that will participate in your “Drop, Cover, and Hold On” drill on October 17, 2013 (or within two weeks of 10/17, on this date: <1>).

Contact Information

First Name

Last Name

Town/City

State

ZIP

County

Country

E-mail

Phone

Permissions

Yes
No

Is it OK to list your name/organization on our website as a participant?

Yes
No

Is it OK to share your information with researchers who are studying ShakeOut activities?

Yes
No

Is it OK to send you e-mail updates about the ShakeOut?

Location Where This Form Was Completed

Event location

If you experience any difficulties with your registration, please e-mail info@shakeout.org for assistance. Please be as specific as
possible about the issue you are experiencing so that we can provide you the fastest response.