EMS ROADDOCS North Texas Chapter Membership Application

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CONTACT INFORMATION AND CURRENT MAILING ADDRESS

DOCUMENTATION: Your documentation of being in the emergency medical system must accompany your application. These are acceptable forms of identification and documentation: ACLS, PALS, CPR, professional license or any other Certificates of Qualification that you feel exhibit your qualifications into the EMS ROADDOC membership. Please do not send originals! We will file your documents in your own personal file folder and hold for others to authenticate if ever questioned. No copies will be made of your documents.

I, (Print your name) _____________________________

am applying for membership into the EMS ROADDOCS riding Club. By signing this application I am declaring that any information that I have provided including documentation is truthful and authentic. I give my consent to the EMS ROADDOCS to perform a criminal background and public records check at their expense.

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