Hollywood Volunteer Rescue Squad, Inc.

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Contact:
301-373-3131

Hollywood Volunteer Resque Squad - Company 79

Members Area
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For Hollywood Volunteer Rescue Squad, Inc. Members Only

In order to gain access to the Members Area, you must fill out the following form completely and press the "Submit Application" Button. All fields in bold are required in order to process your application. Upon verification, you will be notified through e-mail. This process should take no longer than 24 to 48 hours.

General Information

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First Name:

MI:

Address (Line 1):

Last Name:

Address (Line 2):

Phone:

City:

Phone:

State:

Phone:

Zipcode:

E-mail:

Membership Information

Dept ID:
Member Since:	(Year)
Member Type:
Rank:

Certifications:	CPR
	CPR - Instructor
	First Responder
	EMT-Basic
	IV Tech
	EMT-Intermediate
	CRT
	EMT-Paramedic
	Hazmat Technician
	Hazmat Ops
	Rescue Technician
	Instructor I
	Instructor II
	Safety Specialist
	EMS Officer I
	Emergency Vehicle Operator
	Crew Chief

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Hollywood Volunteer Rescue Squad, Inc.
43256 Rescue Lane, P.O. Box 79
Hollywood, MD 20636