Las Vegas Citizen Corps

Electronic Information Request Form

Complete this electronic form to request further information about Citizen Corps programs and volunteer opportunities. Select the specific programs of interest then click the Submit button when complete. Be sure to include the zip code so that information appropriate for your geographical area can be provided.

Name (first & last):  
Street Address:  
City, State, Zip Code:   ,   
Telephone Number:  
Email Address:  
Occupation Skills:  
List all agencies you
currently volunteer for: 		 
 
I would like to receive further information about the following Citizen Corps programs:
 
Community Emergency Response Teams (CERT)
Medical Reserve Corps
Neighborhood Watch Programs
Volunteers in Police Service (VIPS)
Citizen Corps Council Meetings and Activities
I would like a Citizen Corps Council representative to contact me