DEM University Course Request

2. DEM University Training Course Request
   Emergency Management is in the process of researching the need to sustain a number of past DEM University training courses. Through this process we are asking you to fill out this request form. Filling out this form does not guarantee that the courses you've selected will be hosted by DEM - the decision to host a class depends on the number of people interested, and the yearly quarter selected. Include your email address if you wish to receive an email notification when a DEM University class is open for registration.

   Emergency Management is in the process of researching the need to sustain a number of past DEM University training courses. Through this process we are asking you to fill out this request form. Filling out this form does not guarantee that the courses you've selected will be hosted by DEM - the decision to host a class depends on the number of people interested, and the yearly quarter selected. Include your email address if you wish to receive an email notification when a DEM University class is open for registration.

3. Contact Information
   Please enter your contact information below:

   Please enter your contact information below:

5. First Name

6. Last Name

8. Agency Name

9. Job Title

11. Phone Number

12. Email Address

14. Select course your agency is interested in:

    Fill out a separate form for each course if your agency is interested in multiple:

    1. Rescue Systems I
    2. Rescue Systems II
    3. Rope Rescue
    4. Trench Rescue
16. Approximate number of course attendees

17. Preferred Quarter
    -- Select One --3rd quarter 20134th quarter 20131st quarter 20142nd quarter 20143rd quarter 20144th quarter 2014

19. Questions or comments?

21. Thank you for showing an interest in DEM University courses.

Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field