Benicia Volunteer Registration Page

Please fill in the fields below. All fields marked with a * are mandatory.

First Name *
Last Name *
Company
Address*
City*
Zip*
Phone Number*
E-mail *

Please select one or more items of interest below.

Sign me up for an upcoming B.E.R.T. Class. My Company is interested in B.E.R.T.
I'd like to learn more about the Neighborhood Watch Program (NWP). Please have someone contact me 
I'm interested in the Volunteers in Police Service (VIPS). Have someone contact me.
I'm interested in the Volunteers FireDepartment. (VFD) Have someone contact me.
I am a Medical Professional. I'd like to learn more about the Medical Reserve Corps (MRC).
I'm a Licensed Ham Operator. I'd like to join the Neighborhood Ham Radio/BERT Auxiliary and /or RACES.  
                   
 You may enter any message or additional comments below:

Thank you for your interest in Volunteering.

Webmaster@BeniciaCCC.org