Timber Mesa Fire and Medical District

EMS World Expo Contest Entry

Name *

First

Last

Phone Number

Email Address *

Current State of Residence *

EMS Licensure *

Not Licensed
EMT-Basic
AEMT
EMT - Paramedic

Fire Certifications (Please select all that Apply) *

Not Currently Certified
Not Certified but Attending Classes
Haz Mat
Firefighter I
Firefighter II
Fire Inspector I

in or (Please

Currently Employed in Fire or EMS Service? *

Yes
No

Questions or Comments