Fire Department Membership Application

Fire Department

Fire Department Name *

FDID# *

Mailing Address *

Street Address

Address Line 2

City

State

Zip Code

Physical Address *

Street Address

Address Line 2

City

State

Zip Code

Other Counties Served

Station Telephone *

Administrative Contact *

Department Contact E-mail *

Department Website

Consent for storing submitted data *

Yes, I give permission to store and process my data

Key Personnel

Fire Chief *

First and Last Name

Email *

Cell Phone *

Deputy Chief *

First and Last Name

Email *

Cell Phone *

Assistant Chief *

First and Last Name

Email *

Cell Phone *

Services

Please select all that your department provides:

First Responder
EMS Transport
High Level Rescue
Confined Space Rescue

Equipment

Number of Engines: *

Number of Aerial Devices: *

Number of Water Tenders (Tankers): *

Number of Ambulances: *

Number of Rescue Units: *

Number of Specialty Vehicles: *

Number of Brush Trucks: *

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South Carolina
Firefighters' Association

111 Westpark Boulevard
P.O. Box 211725
Columbia, South Carolina 29210

Email: [email protected] Phone: 1.800.277.2732 Fax: 1.803.454.1801

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