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2. Mass Evacuation Transportation Registry
4. This survey is intended to give Onslow County Emergency Management advanced notice that you and/or your household do not have transportation resources available in the event of a mass evacuation of your area of the county in the face of a pending disaster, such as category 4 or 5 hurricane, in which total evacuation of the county has been ordered.
6. Space requirements will limit each individual to one small carry-on bag (small gym bag) that can be placed under your seat. Other restrictions include: no pets, no firearms or other weapons of any kind, no alcoholic beverages, and no illegal substances. Transportation will be provided to a state-designated shelter located somewhere outside the county.
8. Please also bring the following with you:
   • Medications • Extra clothing • Blankets or sleeping bags • Special dietary foods if non-perishable • Flashlight and extra batteries • Infant formula, diapers, baby food • Personal hygiene items • Small toys, puzzles, books, etc. to entertain children
10. Please complete the following information:
12. Name
13. Email Address
15. Address
17. City
18. State
19. Zip Code
21. Phone Number 1
22. Phone Number 2
24. Other individuals in the household requiring transportation assistance
26. First Name
27. Last Name
29. First Name
30. Last Name
32. First Name
33. Last Name
35. First Name
36. Last Name
38. Does anyone listed require transportation in a wheelchair?*

    1. Yes
    2. No
39. Does anyone listed require transportation on a stretcher (bed)?*

    1. Yes
    2. No
41. If so, please identify who:
42. If so, please identify who:
44. Does anyone have special medical needs such as oxygen, respiratory support, IV, Feeding Tube, etc? *

    1. Yes
    2. No
46. If so, please provide additional details:
48. Person completing the form:
50. If you are not one of the registered members, please share your information with us so that we may contact you should we have any questions.
52. We also ask, if you are completing the form on behalf of another, that they are aware of this registration. It is best to print the completed form for them for their records.
54. First Name
55. Last Name
57. Phone Number
59. Email Address
61. Once completed
    Please click submit or submit and print
Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit Submit and Print

* indicates a required field