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Membership Application

Isle of Wight Volunteer Rescue Squad

Membership Application

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Personal Information
Name: Required
Address: Required
Phone Number:
email address: Required
communication preference:
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submitted: 04/30/2025 0239
Certifications
Membership:
OEMS Certification:
please attach current OEMS certification
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Current CPR card:
Please attach PDF of current CPR card
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EVOC certification:
Please attach PDF of current EVOC certification
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ICS 100:
FEMA certification
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ICS 200:
FEMA certification
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ICS 700:
FEMA certification
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ICS 800:
FEMA certification
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Experience/History
Current Employer:
for full time student, respond with "student, school name"
Previous volunteer fire/rescue affiliations:
may we contact previous agencies: yes
no
EMERGENCY CONTACT
Emergency Contact Name:
Relationship:
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Personal References
Reference 1
Reference 1 name:
Reference 1 phone number:
Reference 1 email address:
Reference 2
Reference 2 name:
Reference 2 phone number:
Reference 2 email address :
Reference 3
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Thank you for your interest in joining the Isle of Wight Volunteer Rescue Squad, if you have any questions regarding this memebrship application, please email

Membership@iwvrs.com

 





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Isle of Wight Volunteer Rescue Squad
13080 Great Spring Road
Smithfield, Virginia 23430
Emergency Dial 911
Non-Emergency: 757-357-2587
Station Fax: 747-358-0506
E-mail: info@iwvrs.com
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