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DID YOU KNOW?

You can see photos from last year's ShakeOut drill online and share yours with others!

If you give permission to be listed as a participant, you will be included on the participant list page for your county and area.


February 7, 2012, Paper Registration Form

This form is for entering registrations collected via paper forms completed at events, or for people at events to register online with a simplified form.

By completing the form, people or organizations agree to participate in the Great Central U.S. ShakeOut
"drop, cover, and hold on" earthquake drill on February 7, 2012, at 10:15 a.m.

1. Category

 Individual/Family (if under 18, ask a parent to register)

 Organization

    

       Organization Name:

        I have authority to submit this participation form on behalf of my organization.

2. Number

Number of people you represent (in your family or in your organization, including yourself) that will participate in the statewide "Drop, Cover, and Hold On" drill on October 20, 2011:*

3. Contact Information

Contact Name:   
City:   State:      ZIP: 
Email:
Phone:  

Organizations only:
Title:
Department:
Address:

4. Recognition

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

5. Next Step:

If you provided an email address you will be sent a confirmation for updating your information. Registered participants will receive ShakeOut updates and other earthquake information via email. Please only click the button below ONCE, unless you are told information is missing.



©2012 SCEC Southern California Earthquake Center USC
Central U.S. ShakeOut Step 1: Secure it now! Step 2: Make a plan Step 3: Make disaster kits Step 4: Is your place safe? Step 5: Drop, Cover, and Hold On Step 6: Check it out! Step 7: Communicate and recover!