APPLICATION - Come volunteer with us

First name

Last name

Mobile Phone (text accepted)

Address

City

State

Zip Code

Wisconsin COUNTY of Residence

Position Desired

Preferred District

Relative Experience

WI License Number

Licensure level

I authorize verification of criminal history and licensure.

I grant permission for the use of my image and likeness for training and media.

I assume all risks associated with participation

I agree to uphold professional standards and follow all policies.

I accept responsibility for the issued equipment and understand that I must fund my uniform order through the approved supplier. Logos are copyrighted and may not be used without the express consent of the commander/board.

I certify that I am fit to participate. I am solely responsible for any medical expenses sought on my behalf during emergencies.

I will not incur expense or obligate the Association in any form or manner.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Link to CV/LinkedIn

By submitting this application to the WI EMS Honor Guard, I permit the verification of any information provided.

I understand that any false statements or omissions may lead to my dismissal or denial of membership.

I authorize the WI EMS Honor Guard to investigate the information in this application.

I certify that my EMS license and any other professional licenses have not been restricted, revoked, or terminated.

I release the WI EMS Honor Guard and its agents from liability regarding the accuracy of this information.

I acknowledge my membership in a District and hold the District and State Association harmless from any claims that may arise.

I acknowledge I am not authorized to act or speak on behalf of these organizations, nor may I incur expenses or liabilities for them.