INTERESTED IN BECOMING A MEMBER OF PFFPNC? PLEASE COMPLETE THE FORM BELOW.

Name *

First

Last

Phone *

Address EMS selected

Email *

Address *

Address Line 1

Address Line 2

City

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Zip Code

Preferred Contact Method *

Do you currently work for a professional firefighting or EMS agency in NC? *

• Yes
• No

If you selected "Yes" above, please list the agency name and location below.

Are you currently an IAFF member? *

• Yes
• No

Please list any additional questions below.

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