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* 1. Fire Department Name

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* 2. Fire Department ID  <FDID> (if known)

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* 3. What type of organization do you represent?

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* 4. What type of EMS Service does your organization provide? (click on the highest level you provide)

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* 5. Does your organization have a full time Fire Chief?

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* 6. What is the makeup of your organization?  List the number of each type of firefighter:

  Number
Career
Contracted
Part Time\Paid on Premise
Paid on Call
Volunteer
Non Response\Support
Other

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* 7. What is the population of the primary response are served by your organization? (approximate is OK)

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* 8. About how many miles does your organization provide primary fire response coverage for?

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* 9. If your organization has a labor union, what is the Local Number? If not, you can skip this question.

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* 10. (Optional) Your Name:

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* 11. (Optional) Your Email Address

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