Wayne Township Memorial First Aid Squad

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Join the Wayne Township Memorial
First Aid Squad

Please fill out the form below and a membership committee member will contact you shortly or you fill out this pdf document and mail it to us.

Visit our FAQ Page which has answers some of the basic questions.

First Name:
Last Name:
Address:
City: State: Zip Code:
Country :
Home or Cell Phone Telephone: Age:
E-Mail:
Occupation: Employer:
Scheduling Preference: Day Evening Unknown
Have you previously served on a Volunteer First Aid Squad? Yes No
Experience, skills, Training and Certifications (EMT, CPR, First Aid, NIMS, ICS, etc) Please list type and expiration date:
What is the best time to reach you to arrange an interview?:

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 MEMBER WHEN ENGAGED IN TREATING THE PUBLIC.