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.


Individual and Family Registration Form

Complete the form below to register as an individual or family to participate in the Great California ShakeOut
"drop, cover, and hold on" earthquake drill on October 20, 2011. (This time is preferred, though you can hold your drill at another time or day if best for your schedule.)

Our Other ShakeOuts page has links for registering for other ShakeOut locations.

Past participants: If you registered in 2009 or 2010, please log in to register for 2011.

As a registered ShakeOut participant you will:

  • Be counted in the largest earthquake drill ever!
  • Be included on lists of who is participating in your area (optional)
  • Be an example that motivates others to participate and get prepared
  • Be updated by email with ShakeOut news and information about earthquakes and preparedness
  • Be provided a customized Certificate of Participation to download after the drill (when you register, be sure to list your name as it should appear on the certificate)

Items marked by " * " are required.

Participation

I/We will have a Drop, Cover, and Hold On drill at 10:20 am on October 20, 2011.*		 Yes
Number of people you are registering that will participate in the ShakeOut, including yourself: *

Is it OK to list your name as a participant on the ShakeOut.org website or in other materials?
(First and last name, city, year(s) of participation)*		  Yes
 No
Is it OK to share your information with researchers studying the ShakeOut?*       Yes
 No

Contact Information
Contact Name: *    *
City:    State:       ZIP: * 
County:    Country:  
Phone:
Email: *
(Enter same address twice
to ensure it is correct.)
*
One valid email address only (same in each box)

From which source(s)
did you learn about the
Great California ShakeOut?		 ShakeOut / Earthquake Country Alliance
My employer
Another organization
My child or my child's school
Other friends or family
Facebook, Twitter, or blog
1-800-PREPARE.com
Television, radio, newspaper, or online news
Meeting or preparedness fair
Other:
Complete Your Registration:

NOTE: If you have a strict spam filter: Before submitting your registration, please allow emails from info@shakeout.org so you will receive our confirmation email. (Each email provider handles this differently.You may need to add info@shakeout.org to your email address list or to your spam filter "whitelist".)

Only click the button below ONCE. (If you have missed a required field, a note will appear. Enter the information and then click the button again.) If the form is complete, you should see a confirmation page, and receive a confirmation email within 10 minutes. If the email does not arrive, first look for it in your "spam" folder, then email info@shakeout.org for assistance.



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