Fire Medics Application

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Please correct the field(s) marked in red below:

Yes, I want to join the Fire Medics Program!
Membership is available to Newport Beach residents or business owners.

For residents who receive a municipal services statement from the City of Newport Beach, a membership fee of $14 will be added to your bi-monthly bill ($84/year).
For qualifying business members, the fee structure is as follows:
- $84 standard subscription fee for business with 10 owners and employees.
- $25 additional charge per group of 10 owners and employees for a maximum of 150 employees (14 additional groups) and a maximum subscription fee of $434.
Residents or Business Owners that do not receive a municipal bill will be invoiced the full membership fee annually.
Learn more about the Fire Medics program.

First Name:

Last Name:

Business Name:

Service Address:

Apartment # or Suite:

City:

Zip Code:

Phone:

Phone:ext.

Number of people in home or business:

Email Address:

Mailing Address (if different from above):

City:

State:

Zip Code:

Preferred Method of Contact:

Phone

U.S. Mail

**Your information will be kept confidential. We will not release your information to anyone else.

www.newportbeachca.gov/firemedics

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