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PLEASE SUBMIT YOUR RESPONSES BY FRIDAY, FEBRUARY 1, 2013. If you have questions, please call Jeff Barrington at 1-800-547-7377 ext. 6229.
Department name: *
Town/City/County *
State/Province *
Community character: *
Response area in square miles: *
Population protected: *
Annual operating budget: *
Total fire calls in 2012 (non-EMS responses): *
Total EMS calls in 2012 (if not applicable, please enter NA): *
Number of stations: *
Total pieces of emergency response apparatus (excluding staff cars): *
Number of full-time career members: *
Number of volunteer members: *
Number of paid-on-call members (if not applicable, please enter NA): *
Number of part-time career members (if not applicable, please enter NA): *
How many full-time equivalents (FTEs) does your department use (if not applicable, please enter NA)? *
ISO Rating: *
Name of person completing form: *
Rank of person completing form: *
Contact Information
Address 1 : 
Address 2 : 
City : 
    State/Province     Zip
Email Address
Contact Information
Phone Number : 
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