Contact Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Full Name *FirstLastEmail *Mobile Phone Number *Full Ten (10) Digit Telephone Number from Political Nuclear Mailing Address *Example: 123 Main Street, San Francisco CA 94001Date of Birth (DOB) *Example: 1/1/2000Will You Be Attending? *(Select One)YesNoTenativeHow many additional guests are you bringing? *(Select One)None, just me.+1+2+3 or moreHave You Attended Previous Desert Blast Events? *(Select One)Yes - I have previously attendedNo - I have never attendedWho is Your Emergency Contact? *Name, Email, Phone, RelationshipWhat is your Mothers Maiden Name? *Example: SmithDo You Have Adequate Camping Experience and Supplies? *(Select One)YesNoMaybeDo you know how to drive a vehicle with a manual transmission? *(Select One)YesNoMaybeAre you, or have you ever been, a police officer for any local, state, or federal, agencies? *(Select One)YesNoMaybeWhat are your Vehicles State and License Plate Numbers? *Example: California 2GTW293Is Your Vehicle AWD or 4x4 Capable? *(Select One)NoYesUnsureDoes Your Vehicle Have Chains or Studded Snow Tires? *(Select One)YesNoUnsureDo You Have Any Food Allergies? *(Select One)NoYesUnsureWill You Have Any Pets or Service Animals With You? *(Select One)Yes - DogYes - CatYes - Dogs & CatsYes - OtherNoneHave You Been Diagnosed With Any Heart Conditions In The Last Six (6) Months? *(Select One)NoYesAre You Currently Taking Any Doctor Prescribed Medications? *(Select One)YesNoHave You Been Charged or Convicted of Any Felonies in the last 10 years? *(Select One)YesNoMaybeHave you, or any business associated with you, ever been involved in a law suit? *(Select One)YesNoDo you suffer from or have been diagnosed with Photosensitive Epilepsy? *(Select One)YesNoUndiagnosedDo You Have A Valid State Drivers License and Proof of Insurance? *(Select One)Yes - License & InsuranceNo - Only LicenseNo - Only InsuranceNo - Neither License or InsuranceUnsureDo You Have An Active FAA Drone Pilot License? *(Select One)YesNoUnsureAre You Forklift Certified? *(Select One)YesNoExpiredDo You Have Any Special Skills, Certifications, Degrees, or Equivalent Experience? *(Select One)YesNoMaybeDecline to AnswerUndecidedAre you, or have you ever been, CPR Certified? *(Select One)Yes - I am currently CPR CertifiedYes - I was CPR Certified in the pastNoMaybeDo You Have An Event Sponsor? *(Select One)Yes - Corporate SponsorYes - Professional SponsorNoDo You Have A Preferred Contact Method? *By EmailBy Phone CallBy SMSBy USPS Certified MailDo You Have A Preferred Contact Time? *MorningsAfternoonsEveningsTwilightDisclaimer: We (desertblast.net) make no warranties, either express or implied, regarding the accuracy, reliability, or completeness of the information provided on this website. We are not responsible for any errors or omissions, and we disclaim all liability for any damages, including direct, incidental, consequential, or punitive damages, arising out of the use of this information. *Yes - I have Read the Disclaimer and AgreeYes - I have NOT Read the Disclaimer and Agree AnywayRelease of Liability: I (you), hereby release and forever discharge desertblast.net, its officers, employees, agents, and representatives, from any and all claims, demands, actions, causes of action, or suits of any kind or nature whatsoever, arising out of or in any way relating to my participation in Desert Blast, including but not limited to injuries, damages, or losses of any kind and agree to pay damages in full within 30 days without prior authorization. *Yes - I have Read the Release of Liability and AgreeYes - I have NOT Read the Release of Liability and Agree AnywayArbitration Agreement: If a dispute arises out of or relates to this contract, or the breach thereof, and if the dispute cannot be settled through negotiation, the parties agree first to try in good faith to settle the dispute by mediation administered by the American Arbitration Association under its Commercial Mediation Procedures before resorting to arbitration, litigation, or some other dispute resolution procedure. *Yes - I have Read the Arbitration Agreement and AgreeYes - I have NOT Read the Arbitration Agreement and Agree AnywayNRC Terms and Conditions: I (you), agree to follow and obey all Nuclear Regulatory Commission (NRC) Regulations Title 10, Code of Federal Regulations, applicable to Requirements binding on all persons and organizations who receive a license from NRC to use nuclear materials or operate nuclear facilities and act responsibility to report incidents to the National Response Center by calling 800-424-8802. *Yes - I have Read the NRC Terms and AgreeYes - I have NOT Read the NRC Terms and Agree AnywayAre You Interested in Making a Donation? *Yes - I'm interested in making an on-going monthly donationYes - I'm interested in making a one-time donationMaybeNoAre You Interested in Participating in a Survey? *Yes - Contact me to be a survey participantNo - Not interested in participatingDo You Have Political Interests? *(Select One)Yes - RepublicanYes - DemocartYes - IndependentYes - Its ComplicatedYes - OtherNo - NoneDo You Have A Conceal Cary Permit? *(Select One)Yes - In multiple statesYes - In one stateNoAre you Righthanded, or Lefthanded? *(Select One)Right HandedLeft HandedAmbidextrousSign Up, Opt-In, to Receive Emails From Us *Yes - Sign me up for All EmailsYes - But Only Essential EmailsNo - Never Send Me Emails, EverSign Up, Opt-In, to Receive SMS Text Messages From Us (Carrier Rates May Apply) *Yes - Sign me up for All SMS Text MessagesYes - But Only Essential SMS Text MessagesNo - Never Send Me SMS Text Messages, EverOn a Scale of 1-10, how likely would you be to recommend the products or services from desertblast.net to Friends, Family, or Co-Workers? *(Select One)10987654321Do You Have Any Personal or Professional Questions, Comments, or Concerns? *How Did You Hear About Us? *(Select One)Online SearchOnline ArticleWord of MouthCo-WorkersFriends & FamilyVulcan Mind MeldAlien TelepathyBanner or BillboardRate Your Experience *☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆Submit Go Back To The Home Page