Lee County Citizen Corps Sign Up Form

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.

Read about the programs associated with the Lee County Citizen Corps

Which program or programs are you interested in?*

Community Emergency Response Team
Neighborhood Watch
Volunteers in Police Service
Medical Reserve Corps
American Red Cross
Lee County Emergency Management
Amateur Radio Club
Salvation Army
Clergy Disaster Team
City of Cape Coral
City of Fort Myers
City of Sanibel
Business Disaster Preparedness Council
Emergency Medical Services
City of Bonita Springs
Town of Fort Myers Beach
Lee County Economic Development
AmeriCorps
Lee County Administration
First Name:*
Middle Initial:
Last Name:*
Address:*
City:*
State:*
Zip Code:*
(5 digits only XXXXX)
Occupation:
Comments:
E-mail Address:
Fax Number:
   
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 "Reset" 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).