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Questions marked with a * are required
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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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