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Swiftwater Rescue Technician (SRT1 & SRTA) Enrollment Form #1
Please complete enrollment form to reserve a spot in the up coming SRT course May 27-June 1, 2012. You will receive an email confirmation within (7) business days. Please ensure that you mark the most appropriate agency affiliation. If you have any questions or issues with this form, please contact the SRT coordinator at
chvsrt@gmail.com
. Completing this enrollment form does not guarantee a spot in this course.
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Last Name
*
Your answer
First Name
*
Your answer
Email 1
*
Your answer
Email 2
Your answer
Phone Number
*
### - ### - ####
Your answer
Agency Affilliation
*
Group 1
Choose
Select One
Alpine Fire Protection Distric
Barona Reservation FD
Bonita Fire Protection District
Borrego FD, City of
Carlsbad FD, City of
Chula Vista FD, City of
Coronado FD, City of
Del Mar FD, City of
El Cajon FD, City of
Encinitas FD, City of
Escondido FD, City of
Imperial Beach FD, City of
La Mesa FD, City of
Lakeside Fire Protection District
Lemon Grove FD, City of
National City FD, City of
North County Fire Protection District
Oceanside FD, City of
Pauma Reservation FD
Poway FD, City of
Rancho Santa Fe Fire Protection District
Rincon Reservation FD
San Diego Fire-Rescue, City of
San Marcos FD, City of
San Miguel Fire Protection District
Santee FD, City of
Solana Beach FD, City of
Sycuan Reservation FD
Viejas Reservation FD
Not Listed
Agency Affilliation
*
Group 2
Choose
Select One
Boulevard FD
CAL Fire
Camp Pendleton FD
Campo FD
Campo Reservation FD
Deersprings FD
Deluz FD
Elfin Forest/Harmony Grove FD
Federal Fire
Inter Mtn FD
Julian/Cuyamaca FD
Mesa Grande Reservation FD
Miramar FD
Mt Laguna FD
Ocotillo Wells FD
Pala Reservation FD
Palomar Mtn FD
Pine Valley FD
Rainbow FD
Ramona FD
Ranchita FD
Rural FD
San Pasqual FD
Santa Ysabel FD
Shelter Valley FD
Sunshine Summit FD
Valley Center FD
Warner Springs FD
Not Listed
Do you have a California State Fire Marshal LARRO certificate?
*
Yes
No
Required
Do you have a Rope Rescue Technician(NFPA 1006 & 1670 Level 2 Compliant) certificate?
*
Yes
No
Required
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