Membership Information Sessions

Membership Interest Form

Thank you for your interest in membership with PVAC! Please complete the short information form below and someone from our Corps will contact you to follow up on your interest.

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* 1. Please enter your current information

Name: *

Address: *

City/Town: *

State: *

ZIP:

Email Address:

Preferred Contact Phone Number: *

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* 2. How did you hear about this information session?

PVAC's website (www.perintonambulance.org)

PVAC's official Facebook page or a Facebook Advertisement

Twitter

Word of mouth (if so, from whom and where?)

Stopped in to your base

Other (please specify)

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* 3. Are you at least 16 years of age?

Yes

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* 4. What type of membership are you interested in?

Full (Dispatcher, Driver, Medic)

Auxiliary (support services)

Non-Corps Board of Directors (must meet residency requirements)

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* 5. For planning purposes, which information session do you plan to attend?

Tuesday, August 23rd at 7:00 pm

Saturday, August 27th at 9:00 am

Wednesday, August 31st at 7:00 pm

I can't attend any of these, but am interested in membership. Please contact me!