Welcome to the Lebanon Twp. First Aid Squad On-line Membership Interest Form

  • INSTRUCTIONS:

  • Please Fill out the Form below, and submit it once done.

  • Once the form is submitted, a member from our Membership Committee will contact you to follow up on your Interest Form.

  • Any Questions or Comments, feel free to email the Membership Committee at Membership@19rescue.org or call 908-638-6851. 
  • This Form uses a Secure, 128 Bit Encryption Method to send the information to us.  See The Secure Site Seal Below. 
LTAFS Online Membership Interest Form
Interested in Which Position/Section? (Select ALL that apply) (Click on Any Position for More Info).
Emergency Medical Technician (We will Train, no experience necessary) Driver (We will Train, No experience necessary) Service Association (Aux. Membership which supports the squad with Fundraisers, Administrative Work, Etc...)
Personal Information:
Name (Last, First - M.I.,): ,
Date of Birth:   (Ex. 01/01/1980)
Home Phone:  (Ex. (908) 638-4220)
Cell Phone:    (Ex. (908) 638-4220)
E-Mail Address:   
Current Address:    (Street/PO Box)
City:    (Mailing Address City)
State:   Zip Code:    (Mailing Zip Code)
Best Time to Contact:
  Morning (8AM-12PM) |||  Afternoon (12PM - 6PM) |||  Evening (6PM - 9PM)
Preferred Contact Method:
  Email    Cell Phone   Home Phone   U.S. Mail
Comments/Notes: