Fire Medics Application

Share & Bookmark, Press Enter to show all options, press Tab go to next option
Print

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 $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.
1
First Name:
 *
2
Last Name:
 *
3
Business Name:
4
Service Address:
 *
5
Apartment # or Suite:
6
City:
 *
7
Zip Code:
 *
8
Phone:
 *
9
Number of people in home or business:
 *
10
Email Address:
11
Mailing Address (if different from above):
12
City:
13
State:
14
Zip Code:
15
 Preferred Method of Contact:
 *
Preferred Method of Contact:
**Your information will be kept confidential. We will not release your information to anyone else.

www.newportbeachca.gov/firemedics
    CAPTCHA
    Change the CAPTCHA codeSpeak the CAPTCHA code