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First
Name:
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Last Name:
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Address:
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City:
State:
Zip Code:
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Country :
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E-Mail:
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If you do not live, work or go
to school in Wayne, please tell us why
you would like to be a volunteer for our
community.
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Experience, skills, Training and Certifications
(EMT, CPR, First Aid, NIMS, ICS, etc)
Please list type and expiration date:
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What is the best time to reach you to arrange
an interview?:
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If
you have a disability and require reasonable
accommodations for a disability, please
check this box in order for us to make
special arrangements.
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ALL
STATEMENTS OF FACT MADE HEREIN ARE CORRECT
TO THE BEST OF MY KNOWLEDGE. IF I AM ACCEPTED
AS A MEMBER OF THE WAYNE MEMORIAL FIRST
AID SQUAD, I PROMISE TO CONDUCT MYSELF IN
ACCORDANCE WITH THE RULES AND PURPOSES OF
THE SQUAD AND TO CONDUCT MYSELF IN A PROFESSIONAL
MANOR WHEN ENGAGED IN TREATING THE PUBLIC.
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