CERT Information Request To request information, complete the form below. You must be 18 years of age or older and live and/or work in Arlington County to join. Please be sure to enter these two email addresses, so that they are not blocked by your spam blocker. CERTArlingtonVA@gmail.com and CERTArlingtonVA.App.Registrar@gmail.com Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Civic AssociationFind your Civic Association (opens in a new window)SelectAlcova HeightsArlington - East Falls ChurchArlington ForestArlington HeightsArlington RidgeArlington ViewArlingwoodAshton HeightsAurora HighlandsBallston - Virginia SquareBarcroftBellevue ForestBluemontBoulevard ManorBuckinghamChain Bridge ForestCherry Valley Nature AreaCherrydaleClaremontClarendon - CourthouseColonial VillageColumbia ForestColumbia HeightsColumbia Heights WestDominion HillsDonaldson RunDouglas ParkDover CrystalFairlingtonForest GlenFt. Myer HeightsForest HillsFoxcroft HeightsGlebewoodGlencarlynGulf BranchHighland Park - Overlee KnollsLangston - BrownLeewayLong Branch CreekLyon ParkLyon VillageMadison ManorMaywoodNauckNorth HighlandsNorth RosslynOld DominionOld GlebePenroseRadnor/Ft. Myer HeightsRivercrestRiverwoodRock SpringsStafford-Albemarle-GlebeTara - Leeway HeightsWaverly HillsWaycroft - WoodlawnWestover VillageWilliamsburgWoodmontYorktownHow did you hear about the Arlington CERT?Please be aware that information submitted through an Arlington County Government website is considered to be a Public Record under the Virginia Public Records Act and may be subject to release by the County in response to a request made under the Virginia Freedom of Information Act.Arlington County may withhold your name and contact information in accordance with the Virginia Freedom of Information Act. Please indicate, by checking the box below, if you would like for the County to seek to keep this information confidential.Do Not Disclose Opt-Out Please do not disclose my name and contact information in response to a request under the Virginia Freedom of Information Act. I recognize that the County cannot guarantee the confidentiality of my name and contact information but ask that it do so to the extent permitted by law. NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.