Whitestone Community Volunteer Ambulance Corps

P.O. Box 570064 Whitestone N.Y. 11357   (718)767-1000

                                     
 On-Line Membership Application

If you are interested in joining the Whitestone Community Volunteer Ambulance Service, you can complete this form and the information will be given to the Membership Committee. The Committee will contact you shortly. You may call us at 718-767-1000 and leave your name, telephone number and the best time to contact you.  

Please provide the following contact information:

First Name
Last Name
Middle Initial
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
E-mail

Please identify and describe yourself:

Date of Birth
Sex Male Female

Choose one of the following options:

High School
College
Post Graduate
Other

What kind of Membership are you interested in?

Driver/Attendant
Dispatcher
Youth Squad

Select any of the following Certification options that apply:

CPR
First Aid Responder
Emergency Medical Technician
Paramedic
Other

Thank you for applying to the Whitestone Community Volunteer Ambulance Service. By pressing the "Submit Form" button above, the information you have entered will be forwarded to the Chairperson of the Membership Committee. The Committee will be contacting you, by phone, within a week or so. Please understand that you will be aked to meet with the Committee for an interview.

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Copyright © 1999 Whitestone Community Volunteer Ambulance Service Inc. All rights reserved.
Revised: July 08, 2002