Join MRC GEM

Help yourself, your family, and your community prevent and deal with disasters

Every emergency response situation requires a variety of skills to ensure that things run smoothly and effectively. To join us, complete the registration form below and we’ll get back to you shortly to confirm.

Thank you for your interest in assisting public health by joining MRC GEM. Anyone at least 18 years of age is welcome to join. (Anyone under 18 and at least a high school junior is welcome to attend meetings along with an adult guardian who is a member.) Please complete the following, then click "Submit". We will send you an email to confirm receipt of your membership application. If you do not hold a valid current Georgia healthcare provider license, you must click the link in that email to download a background check form; follow the instructions on that form.

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

County(Required)

Date of Birth(Required)

Gender(Required)

Please provide ways we can contact you in an emergency:

Contact method 1(Required)

Phone Number 1(Required)

Contact method 2

Phone Number 2

Contact method 3

Phone Number 3

Email address(es) for regular announcements (in order of preference):

Email 1(Required)

Email 2

Other important information

Emergency contact person(Required)

Relationship(Required)

Emergency Contact Method 1(Required)

Emergency Contact Phone Number 1(Required)

Emergency Contact Method 2

Emergency Contact Phone Number 2

Occupation

Your Occupation License Number (if any)

State of License

State

Language you know (other than English)

Spoken Level

Written Level

Second Language you know (other than English)

Spoken Level

Written Level

Anything that might affect your ability to assist in an emergency or might otherwise require special accommodations?

Please tell us specifically how you heard about us.(Required)

Join MRC GEM

Help yourself, your family, and your community prevent and deal with disasters

Join MRC GEM

Please provide ways we can contact you in an emergency:

Email address(es) for regular announcements (in order of preference):

Other important information

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Why Join MRC GEM?

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