Citizen Corps: Subscriber Registration

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Subscriber Registration

If you would like to participate in Citizen Corps, please provide your contact information below, then click "Submit." We will send you e-mail updates about Citizen Corps activities around the country. Your state and local Citizen Corps Councils will also be able to contact you to let you know about local events and activities.

Which program or programs are you interested in?*

Community Emergency Response Teams
Neighborhood Watch
Volunteers in Police Service
Medical Reserve Corps
National Citizen Corps Council
Other

First Name:*
Middle Initial:
Last Name:*
Address:*
City:*
State:*
Zip Code:*	-
	(99999 or 99999-9999)
E-mail Address:*
	(xxx@yyy.zzz)
E-mail Address Confirm:*
	(xxx@yyy.zzz)
Occupation:

By submitting this form, you are agreeing to the release of your name, address and contact information to the State and Local Citizen Corps Councils for the area in which you live and to the organizations that manage the programs in which you have indicated an interest. If you do not agree, please click on "Cancel" below

Privacy Act Statement In compliance with the Privacy Act of 1974, the following information is provided: the collection of this information is authorized by 5 U.S.C. 301 and Section 2, Executive Order 13254, January 29, 2002. The primary purpose of the form is to provide a means of communication with individuals who have indicated an interest in the Citizen Corps mission and in specific areas of volunteer service. Providing this information is voluntary. All information submitted by a user is available to Citizen Corps (including individual State and Local Citizen Corps Councils), USA Freedom Corps, those entities in which user expresses an interest, and other entities as specified in the Notice published at 67 FR 30685-01 (May 7, 2002).
*OMB No. 1660-0078, Expiration Date: 07/31/2006*