Membership Application

If you or someone you know is interested in joining our Association, please complete the information below and mail with your payment to:

Select Membership Status you Request:

___ $45 - Individual Combined NEMA + NAEMT

___ $15 - Individual NEMA only

___ $42 each - Squad Combined NEMA + NAEMT, first 20 members

___ $45 each - Squad Combined NEMA + NAEMT, member 21 through...

Membership is one year.  Renewal notice will be sent at anniversary of membership

NEVADA EMERGENCY MEDICAL ASSOCIATION

P.O. BOX 538, CARLIN, NV 89822

Name_________________________________

Address_______________________________

______________________________________

City, State_______________________  ______

Zip___________________________________

Phone ________________________________

Fax __________________________________

Email________________________________

Service_______________________________

Nevada Certification Number______________

NREMT #______________________________