Duffle Bag Application Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *Address (Street and House #) General Criteria (check all that apply) I have at least 72-hours of emergency supplies (food, water, other)My block has held at least 2 block activities in recent yearsI attend, or plan to attend, the MPC Ready monthly meetingsMy block has at least 15 householdsBlock Activities (descriptions & dates) Any other event or comment? Block Roster & First Aid Related Skills (check all that apply)My block has a neighborhood roster that’s kept current.I keep the roster current.I have taken the CERT training within the past 3 years.I am a HAM radio operator.I have taken CPR/First Aid within past 2 years.I have taken Stop the Bleed within past 2 years.How Many Households on Your Block? Please tell us a little bit about your block. The City of Menlo Park would like us to supply composite demograhic information, such as how many elderly, children, vulnerable populations, etc. Please estimate where possible. Custom Captcha * = Submit