First Name:    Last Name:

 Email Address: 

Mailing Address:

Mailing City: State: Zip:

Phone Number:

What type position are you interested in? Paid Volunteer

If you are currently a patroller enter your patrol number here:

Check which medical certifications you have.

Current CPR  Expiration Date  

 Current OEC  Expiration Date   OEC# 

  Current EMT  Expiration Date   EMT State and # 

   Current WEMT    Expiration Date   WEMT State and # 

 In OEC/EMT class now

Describe your medical certifications and experience below:

Describe your skiing/riding experience and state any certifications

Have you ever patrolled anywhere before? If so, describe below: