Tier 1 - Starter Membership (No Fees)

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Tier 1 membership includes:

- Email List—(Providing access to volunteer opportunities, WFA Events, and more)

- Newsletter—(Keeps you updated on issues pertaining to women in the Fire Service, and all things related to the WFA)

- Placement in a mentorship group to learn alongside your peers

- 10% discount all WFA Merchandise

Name / Today's Date *

Email *

Phone Number (For Mentorship Groups)

Current Position. *

Sworn FF

Sworn FF / Paramedic

Fire Engineer

Fire Captain

Battalion Chief

Fire Marshal

Assistant Fire Chief

Fire Chief

Ambulance Operator

Explorer

Cadet

EMT (Private Company)

EMT (With a FD)

Paramedic (Private Company)

Paramedic (With a FD)

Other:

Goal?

Firefighter

Firefighter / Paramedic

EMT

Paramedic

Lifeguard

Fire Inspector

Fire Investigator

Other:

Clear selection

Age

16-18

19-24

25-33

34-40

40-50

50 +

Clear selection

Would you like to be placed in a mentorship group of your peers?

Yes

Maybe, I need more information - please email me.

Other

Clear selection

Race - Optional - To help us apply for grants.

White (A person having origins in Europe, the Middle East, or North Africa, German, Irish, English, Italian, Lebanese, Egyptian, Polish, French, Iranian, Slavic, Cajun, Chaldean, etc.)

Black (African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, Ghanaian, South African, Barbadian, Kenyan, Liberian, Bahamian, etc.)

African American (African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, Ghanaian, South African, Barbadian, Kenyan, Liberian, Bahamian, etc.)

Native American (North and South America (including Central America), Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, or Nome Eskimo Community.)

Asian (Far East, Southeast Asia, India, China, the Philippine Islands, Japan, Korea, Vietnam, Chinese, Filipino, Korean, Japanese, Vietnamese, Pakistani, Cambodian, Hmong, Thai, Bengali, Mien, etc.)

Pacific Islander (Hawaiian, Chamorro, Samoan, Other Pacific Islander, Palauan, Tahitian, Chuukese, Pohnpeian, Saipanese, Yapese, etc.)

Prefer not to answer

Other:

Clear selection

Gender - Optional - To help us apply for grants.

Female

Male

Gender Non-Binary

Prefer not to say

Other:

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms