Join FireMed Printable Enrollment Form

Please complete your information on each step. Fields with a red * are required fields. After reviewing your information on the Order Summary step, click ‘Confirm & Pay’ or correct any error message noted in red.
To change any item, go to the appropriate Step and make update. When finished, go to the Order Summary step, review, and click ‘Confirm & Pay’. A confirmation message will appear when the order is successfully submitted.

Choose which package you would like, or learn more about your membership options.

FireMed Basic

Ambulance

Full emergency ambulance coverage for your entire household.

$ 65 /year

FireMed Plus

Ambulance + Ambulance

Full emergency ambulance coverage for your entire household, plus Life Flight Network.

$ 115 /year

That email is already registered. Click here to renew

Passwords must be at least 6 characters long.




Include all additional persons who are primary residents of the same single-family occupancy, non-commercial residence, living together as a family unit, but not to include roomers or boarders.

Click Add Member sign to enter additional household members. If no other members apply, continue to next step.













Donations are used to provide membership scholarships to low income citizens. Thank you for your help!


Home Address (Residence):




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FireMed Basic
$65.00

Total
$65.00
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