Membership Interest Contact Form
Get your name in for consideration for the next start date now!
Date of Birth:
Describe any Fire, EMS, Rescue, or Hazmat experience or certifications you have.
ParamedicNC EMS Certification #:
ERT RT-VMR RT-Ropes RT-Trench RT-Swift Water
Please provide the following contact information:
If you are currently an active member of another Emergency Services Agency please list below:
How did you find out about Parkwood?
Instructor (Specify Below)
Seen Us In The Community
Emergency Services Agency
Other (Specify Below)
Please explain above:
How would you prefer to be contacted?
Initial Contact will be via email, please check regularly for essential communications.