NAEMT Coordinator Application

I am applying for the following coordinator position: *

Advocacy
Membership

EMS certification level: *

First Responder
EMT
Advanced EMT
Paramedic
Other

Name: *

Primary EMS Organization: *

Primary EMS Organization City: *

Primary EMS Organization Zip code: *

Phone #: *

Email: *

My NAEMT ID number is: *

Provide a brief background on your EMS career, including years of experience: *

What is your interest in this position? *

Describe the qualities and strengths you will bring to NAEMT and this position: *

How will you expand and build awareness of NAEMT in your state? *

Are you currently active in your State EMS association? *

Yes
No
My state does not have an EMS association

Will your employer support your participation in this volunteer position? *

Yes
No

Optional: Attach up to three (3) supporting documents - Examples: Resume or CV; Letter of interest; Recommendation: