CERT Service Request Form

Fill out all fields if possible to request CERT Services.

Purpose or Event Type:
Services Required:
Fire Rehab
Parade Route Traffic Control
5k/10k/Race Traffic Control
Traffic Control, Parking Assistance, or other Crowd Control
Community Events (Pancake Breakfast, Fireworks, Fundraisers)
Moulage for Exercises and Drills
Information Booth
Other-Please Specify
Other Specific Request:
Location:
Name of Requesting Organization:
Contact Person:
Contact Email:
Contact Phone Number:
Describe Work on Project:
Special Instructions or Requests:
Will you be giving a donation to the CERT Team for the use of their services? A 501c3 Nonprofit number is available for tax purposes:

Thank you for considering the Des Moines County Community Emergency Response Team to help with your event!