EMS/Mountain Rescue Membership Application
Thank you for your interest in joining Silverton EMS and  San Juan County Mountain Rescue. Only certain fields are required, but please fill out as much of the application as possible.

Please allow at least 45 minutes to complete the application.
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Email *
1) Last name *
2) First name *
3) MI
4) Mailing address *
5) City *
6) State (AA) *
7) Zip code *
8) Physical address (if different from mailing)
9) City
10) State (AA)
11) Zip code
12) Mobile phone number (###-###-####) *
13) Mobile phone type *
14) Mobile phone carrier *
15) Driver license number *
16) Driver license state *
17) Driver license expiration *
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This form was created inside of silvertonrescue.org.