The Three Percenters Original
Disaster Response Team Application and Liability Waiver

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Email *
Full legal name (first middle last)-if no middle name enter middle name as NMN * *
Street Address (Example: 123 Main St.) *
City *
State (Example: AA) *
Zip Code
Phone *
Date of birth *
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Have you completed the 2nd Responder E-course on the Forum?
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Which natural disaster would you like to help with? *
Date Available for deployment on a strike team
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Duration Available for deployment on a strike team
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Known Allergies
Medications and Medical History (Not necessary for those not participating on a Strike Team)
Position applying for: *
Required
Skills & Certifications Summary of applicable skills (medical, first aid, behavioral first aid, construction, transportation, communications, security, etc.). If medical or construction, please be specific.  If you are certified by a recognized body/agency, please specify. *
Prior Disaster Response Experience (Please list the prior experience you have had in disaster response) Disaster Event/Date/Responsibilities and or role. *
Tools and Equipment (Please list the tools, equipment & supplies you are willing to bring, at your expense and risk, to deal with the natural disaster.  Applicable categories include: Medical, Construction, Transportation, and Food/Water) *
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