Fire Medics Application

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Logo 2012-small 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 $10 will be added to your bi-monthly bill ($60/year).
  • For qualifying business members, the fee structure is as follows:
    • $60 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 $410.
  • 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.
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First Name:
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Last Name:
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Business Name:
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Service Address:
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Apartment # or Suite:
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City:
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Zip Code:
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Phone:
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Number of people in home or business:
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Email Address:
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Mailing Address (if different from above):
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City:
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State:
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Zip Code:
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 Preferred Method of Contact:
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Preferred Method of Contact:
**Your information will be kept confidential. We will not release your information to anyone else.

www.newportbeachca.gov/firemedics
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