Membership Application

Membership Application Form
  • Personal Information
  • Background Information
  • References
  • Consent

Section I - Personal Information

All fields marked with an asterisk are mandatory. You will not be able to move to the next section or, complete and submit the form without populating these fields.

Emergency Contacts

Please provide the name of an emergency contact. If you would like to provide a second contact, please select "YES" from the dropdown menu.

Section II - Background Information

Section III - References

List as character references two people you have known for at least two years who are not related to you.

Section IV - Consent

I authorize the investigation of all statements made herein. I certify the information provided in this application is complete and correct to the best of my knowledge. I understand any false statements or omissions of information requested may be just cause for denial of this application, or dismissal from this organization without recourse. Information will be verified through, but not limited to: MD Judiciary, MD Motor Vehicle Association, MIEMSS Compliance Department, NREMT Compliance, Past Department Leadership.

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