California Prepared Membership Application
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First Name
*
Enter your first name here.
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Last Name
*
Enter your last name here.
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Email Address
*
Provide a valid email address for communication.
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Phone Number
*
Enter your phone number.
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City/County of Residence
*
What’s your city or county of residence?
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Age Confirmation
*
Please confirm your over the age of 18.
Yes
No
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Criminal History Declaration
*
Please select your criminal history status.
Select an option
No felony convictions
I have resolved felony conviction(s) through expungement or dismissal
I have pending felony matter(s)
Prefer not to answer at this time
This field is required.
Interest in Preparedness Areas
*
Please select all areas of preparedness that interest you.
Firearm safety and marksmanship
Emergency medical and first aid skills
Communication and radio operations
Land navigation and GPS use
Physical preparedness and training
Emergency planning
Other
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Other Interest (please specify)
If you selected ‘Other’, please specify.
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Submit
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