Neighborhood Emergency Teams - Information Request

2. First Name

3. Last Name

5. Address

7. City

8. State

9. Zip

11. Home Phone

12. Alternate Phone

13. Email

15. Where did you hear about PC NET or Map Your Neighborhood?

16. Date

18. Can you provide us with any additional information about your neighborhood (i.e. demographics, number of homes, etc.)?

20. Thank you for taking the time to act on this great opportunity to get your neighborhood involved in preparing for emergencies. One of Pierce County Emergency Management's PC-NET Coordinators will contact you within the next few weeks. If you have any additional questions, please don't hesitate to contact us by emailing PCDEMoutreach@co.pierce.wa.us or by calling 253-798-6595.

    Thank you for taking the time to act on this great opportunity to get your neighborhood involved in preparing for emergencies. One of Pierce County Emergency Management's PC-NET Coordinators will contact you within the next few weeks. If you have any additional questions, please don't hesitate to contact us by emailing PCDEMoutreach@co.pierce.wa.us or by calling 253-798-6595.

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

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