Members Wanted
Return to Forms Section
Note: An asterisk (*) denotes a required field
1) Name*:
2) Address*:
3) City*:
4) State*:
5) Zip*:
6) Home Phone*: --
7) Cell Phone: --
8) Other Phone: --
9) Age:
10) Current valid Email*:
11) Areas of Interest (If Explorer Post 690 is chosen, please complete the following 2 questions)*: Firefighter
Emergency Medical Technician
Firefighter/Emergency Medical Technician
Explorer Post 690
12) Parent or Guardian Name:
13) Parent or Guardian Contact Phone Number :
14) Previous Experience in the Fire/EMS Service?*: Yes
15) Do you have Friends/Family already in the Fire Service in Nassau County? (if so list names & department)*:
16) Questions/Comments:
17) How did you hear about Volunteering with the Wantagh Fire Department*:
Please provide your email below to receive an email receipt of this form submission.
18) Receipt email address*: