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The Great Southern California ShakeOut
The Great Southern California ShakeOut

Registration Form for Businesses and Organizations

(Includes small, medium, and large businesses, and community groups, scouting troops, government agencies, medical centers, news media, museums, or other organizations)

Please complete this form to register your business or organization as a participant in the ShakeOut. Only items with an asterisk (*) are required.

Business/Organization Information
Organization Name
(as it should appear on our website if you give approval below):*
Organization Type:*  
Organization Website URL:
(Include "http../../")
Number of employees or others you represent that will participate in some manner on November 13:* (digits only -- no text)
Describe your organization's plans for participating in the ShakeOut (you can update this later):
My organization is also an official participant in the Golden Guardian emergency response exercise: Yes
 No
    
Yes!   We agree to participate, and I have authority to register the business or organization named above.*
(If you do not have authority, please ask the appropriate person to register your organization, or return when you have permission.)

To continue with this form, you must click the box above.



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