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EMSPAC NEW MEMBER SIGN UP
Please fill out this from in its entirety to sign up to be a member of EMSPAC. There are no fees, dues, or strings attached.
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* Indicates required question
NAME (First Last)
*
Your answer
NYS DOH Number
*
Input your certification / license number. Input 000 if you do not have one or work outside of NYS.
Your answer
TITLE
*
EMT
EMT-CC
AEMT
EMT-P / NREMT-P
RN
NP
PA
MD / DO
NONE
Other:
Required
AGENCY
*
FDNY EMS
NCPD
MONTEFIORE
NYP
MOUNT SINAI
NYU
MAIMONIDES
RUMC
JHMC
FLUSHING
NORTHWELL
SENIORCARE
CITYWIDE
RCA
EMPRESS
HUNTER
AMBULNZ
MIDWOOD
LIFELINE
PRIORITY ONE
NSA
FIRST RESPONSE
AMR
HATZALAH
CITYBLOCK
AMPHIBIOUS MEDICS
PARADOCS
Other:
Required
GARAGE
*
INPUT YOUR STATION NUMBER AND NAME, BASE LOCATION, OR TURNOUT LOCATION
Your answer
UNION
*
LOCAL 2507
LOCAL 3621
1199SIEU
LOCAL 741
LOCAL 707
CSEA 830
IAEP R220
LOCAL 22
NONE
Other:
Required
CELL PHONE NUMBER
*
Your answer
EMAIL ADDRESS
*
Your answer
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