Fire Medics Application

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Logo 2012-small Yes,  I want to join Fire Medics!
Membership is available to all residents or business owners in Newport Beach

  • For residents receiving a municipal services statement from the City of Newport Beach, $10 will be added to your bi-monthly bill ($60.00/year)
  • Residents or Business Owners that do not receive a municipal bill will be invoiced $60 annually
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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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