Join the movement

Membership Application

Thank you for your interest in membership. Please complete the membership application. A member of the association will reach out to you.

Name

Gender

Date of birth (YYYY-MM-DD)

Phone number

Preferred contact method

Email Address (please do not use a government or employer provided email address for safety and privacy)

Mailing Address

City

State

Zip code

County

T-Shirt Size

Message

Licensure level

PD Endorsement

IC Endorsement

IA Endorsement

Community Paramedic Endorsement

License#

License Expiration (YYYY-MM-DD)

Licensure status

Current Status

Organization

DUES must be paid annually. DUES can be paid by cash, check or digital payment.

Career EMS Professional $50
Retired EMS Professional $25
Career First Responder (Fire/LEO) $50
Volunteer EMS Professional $25
EM Physician or APP $50
Community Advocate/Auxiliary $25
Student $10

Type your full legal name here to sign

Join the movement

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Membership Application