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Registration Form for Businesses and Organizations

Complete this form to register a business, community group, scouting troop, government agency, medical center or facility, news media organization, museum, or other organization that will conduct an earthquake drill on October 20, 2011 at 10:20 a.m., involving the number of participants entered below. (This time is preferred, though you can hold your drill at another time or day if best for your schedule.) Only a "drop, cover, and hold on" drill is required, though you are encouraged to hold a more extensive test of your emergency plan.

All schools, colleges, and child care centers: Please use the Schools/Colleges registration form.

Past participants: If you registered your organization in 2008, 2009, or 2010, please log in to register for 2011.

New participants: If you have authority to register your organization, click the check box to begin.

REGISTRATION FORM

Register on this page for the California ShakeOut. To register for another ShakeOut, select an area:

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 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 and organization as it should appear on the certificate)

      Yes!*  We will participate in the ShakeOut drill on October 20, 2011 (or another date within 2 weeks), and I have authority to register my organization.

    Only items marked by " * " are required.

Business/Organization Information
Organization Name:*
(as it should appear on our website
if you give approval below)
Department:
(will also be listed on the website)
Organization Type:*  
Organization Website:
(Include "http://")
Address:
City:*    State:  
ZIP:*
County:*    Country:  
Number of staff or others you represent who will participate:* (digits only -- no text)
Parent company/organization:
(If your registration should be listed under another organization,
please provide that organization name here)
Describe your organization's plans
for participating in the ShakeOut
(you can update this later):
Is it OK to list your organization as a participant on the ShakeOut.org website or in other materials?* Yes (Org. name, dept., city, year(s) of participation)
 No
Is it OK to share your information with researchers studying the ShakeOut?* Yes
 No

Contact Person
Contact Name:*   *
Title:
Phone:*
Email:*
(Enter same address twice
to ensure it is correct.)*
One valid email address only, please
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". Ask your IT staff if you don't know the procedure.)

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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Great ShakeOut Earthquake Drills