This is a great opportunity for you to help your local fire and emergency services departments as well as your community. To ensure that your time and talents will be best utilized, fill out the following form and submit it. We will be in contact with you within 72 hours of receiving the form. Thank you for your willingness to volunteer! 

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What type of membership are you interested in applying for? (Check one)ACTIVE RESPONDER- Responds to fire, emergency medical and other rescue incidents. Participates in business and other functions of the department and has voting privilegesACTIVE MEMBER - Participates in business meetings, assists with fundraising and other functions of the department and has voting privilegesJUNIOR - Between the ages of 16 & 17, works under the supervision of an advisor or line officer and the P.A. Junior Emergency Service Compliance Manual and has no voting privilegesSOCIAL - A member who works for the support of the department but cannot hold office nor has voting privileges

Certificates - check all that applyPennsylvania Department of Health Emergency Medical Technician (EMT)Pennsylvania Department of Health Emergency Medical Responder (EMR)Pennsylvania Department of Health ParamedicOut-of-State EMT, EMR or ParamedicPennsylvania Firefighter IPennsylvania Firefighter IIOut-of-State FirefighterOtherlist of certifications

If interested in becoming and Active Responder, please list any current fire and/or EMS certificates you have obtained. List all that apply0 / 200

Drivers LicenseYesNoDo you have a current Pennsylvania driver's license?

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