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Register for the 2024 Arizona ShakeOut
Please note that fields marked in
bold
and with an orange asterisk (
*
) are required.
Category
Category
*
Select...
Individuals/Families
Childcare and Pre-Schools
K-12 Schools and Districts
Colleges and Universities
Local Government
State Government
Federal/National Government (Including Military)
Tribes/Indigenous Peoples
Businesses
Hotels and Other Lodgings
Healthcare
Senior Facilities/Communities
Disability/AFN Organizations
Non-Profit Organizations
Neighborhood Groups
Preparedness Organizations
Faith-based Organizations
Museums, Libraries, Parks, etc.
Volunteer/Service Clubs
Youth Organizations
Animal Shelter/Service Providers
Agriculture/Livestock Sector
Volunteer Radio Groups
Science/Engineering Organizations
Media Organizations
Other
Organization Name
*
Which are you registering?
*
The participation of my organization
The participation of a department or other subset of my organization
D
epartment
*
I have authority to submit this registration form on behalf of my organization.
*
Participants
Number
of people that will participate in your “Drop, Cover, and Hold On” drill.
Number
of staff that will participate in your “Drop, Cover, and Hold On” drill.
Number
of students that will participate in your “Drop, Cover, and Hold On” drill.
Contact Information
First Name
*
Last Name
*
Town/City
*
State
*
ZIP
*
County
Select your county...
Multiple Counties
Apache
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma
Other
Country or Region
E-mail
*
Phone
*
ShakeOut Profile Password
(more than 6 characters)
*
Password (again, to ensure accuracy)
*
Organizations only:
Title
Street Address
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?
Your registration is being processed. Please wait a few moments.
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.
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