Name *

Fire Fighter Information

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

T-Shirt Size *

Small

Medium

Large

X-Large

2X

3X

4X

5X

Name of Relative or Friend *

In Case of Emergency

First Name

Last Name

Phone *

Emergency Contact

(###)

###

####

I have been authorized by my Fire Chief to attend the 150 Mile House Fire Department's Annual Training Weekend. *

I am

trained on how to use SCBA and PPE

competent in using SCBA and PPE