LERT Training Attendance Form
BBEC Lookup ID
Record Type
Name
*
Mr.
Mrs.
Ms.
Rev.
Dr.
Rev. Dr.
Deaconess
Title
First Name
Middle Name
Last Name
Suffix
Training Date
*
-
Month
-
Day
Year
Date
Training Code
Training Code
*
Training Location
*
Church Name
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Next
Gender
Male
Female
Primary Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Address Type
*
Home
Business
Country
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Next
Phone Number
*
Phone Type
*
Home
Business
Cell
Cell Phone Number (Inactive)
Email
*
Confirmation Email
Email Type
*
Personal
Business
Registrant T-shirt size
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S
M
L
XL
XXL
All T-shirts sizes are unisex. Once shipped, T-shirts cannot be exchanged.
Information from LCMS Disaster Response
Yes, you can send me information about LCMS Disaster Response
The LCMS may share my application information with LCMS districts and their disaster representative(s). I understand that this will ensure I am informed about future training and service opportunities and can contribute to LCMS Disaster Response’s impact on affected communities through my volunteerism.
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Volunteer Individual Release of Liability
Volunteer Photo
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