The State of Texas will hold a full-scale evacuation exercise June 1-8, 2017, for the Houston/Galveston region. On June 5-6 and June 7-8, we will be testing the ability to evacuate to a shelter, feed, and return evacuees from the affected areas. We are recruiting volunteers to serve as evacuees to be processed through an embarkation hub, transported via motor coach to a shelter where you will stay the night, and then be transported back to the embarkation hub. If unable to serve as an overnight volunteer, there is a second option to volunteer locally at an embarkation hub and participate in the registration process locally without being transported to a shelter. If you are interested in participating, please fill out the survey. A volunteer coordinator will contact you with further details.

* 1. Are you willing to act as a volunteer for the Hurricane Charlie Exercise?

* 2. Are you willing be transported to a temporary shelter, stay overnight, and be bused back the following day?

* 3. If no, are you willing to transport yourself to/from the shelter location to serve as a daytime only volunteer?

* 4. Please enter your first and last name.

* 5. What is your phone number? (Please use XXX-XXX-XXXX format)

* 6. What is your email address?

* 7. What is your home zipcode?

* 8. What days are you available for transport to a shelter for an overnight stay?

* 9. **Only if you are unable to participate overnight: what days are you willing to participate? Click all that apply.

* 10. Do you have any dietary restrictions? Please list or write N/A.

* 11. Do you have any mobility, cognitive, medical, or other disability that would impact your evacuation?

* 12. If you have any functional or access needs, including use of medical equipment such as oxygen, a walker or wheelchair, etc., please indicate that here or write N/A.

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