ECA QuakeSmart Online Workshop Application
Complete this application by January 13 to be considered for participation in the January 27, 2021 ECA QuakeSmart Online Workshop.




Contact Information

Name:*


Primary Organization:

Category:
Title/Role:
# of employees, members, volunteers, etc.:

Mailing Address:
(2 lines, if needed)

City:
 State:   ZIP:*
Phone number:
E-mail address:*

Web Address:
(if applicable)



Participation

Reason for participating (multi-choice):*
Secure my own space
Secure my primary organization's items
Secure another organization's items (please list in next box)
ECA Mini-Award Recipient
Help my community
Start a business for securing items

Additional Organizations/Homeowner Associations/Communities:
(and role, # of members, webpage, etc.)

0/500 characters max

Live captioning will be provided for this workshop.
Do you require any other accommodations in order to fully participate?

0/500 characters max


Experience


What is your experience using power tools such as drills? Please describe.*
Beginner     Intermediate     Experienced


0/500 characters max


Do you have, or have access to, the necessary power tools for doing this work?*
I have my own power tools
I have access to power tools
I have no access to power tools


How would you rate your ability to locate wall studs? (Pick the closest correct answer)*
What is a wall stud?
I've done it before but I wouldn't consider myself an expert
No problem, I do it all the time


What is your experience securing furniture, appliances, TVs, etc. (How many items have you secured?) Please describe.*
0-20     20-50     50-100     100+


0/1000 characters max

Any technical/engineering experience? (for securing major equipment & very large items; or fire safety, ADA accessibility, or other related experience) Please describe.*

0/1000 characters max

Have you attended previous similar workshops? Please describe.*
0/500 characters max