Fixed Membership AppFirst NameLast NameEmailPhone/MobileCell Phone Provider- Select -AT&TT-MobileVerizonMint MobileBoost MobileCricket WirelessConsumer CellularOtherAddressAddress Line 1Address Line 2CityStateZip CodeApplication Type- Select -General Membership (Ages 18+)Junior Membership (Ages 12-17)Please put your guardian's name, email, and phone number below. First NameLast NameGuardian EmailGuardian Phone NumberWhen is your time of day and day of the week availability?Availability Days Afternoons Evenings Overnights RotatingAvailability Sunday Monday Tuesday Wednesday Thursday Friday Saturday RotatingCurrent Certifications CFR EMT-B AEMT EMT-CC Paramedic LPN RN Firefighter 1/2 CPR CPR Instructor EVOC/CEVO PALS/ACLS OtherOther CertificationsPrevious/Current DepartmentsSubmit Form