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Fire Training Registration Form

2. MADISON COUNTY FIRE TRAINING REGISTRATION FORM

3. ATTENTION:

   Registration for all Madison County course is now mandatory. Registration priority is given to County agencies, their regular mutual aid partners, then out of county students. It is the responsibility of the student to contact the fire coordinator if they have registered for a course and their availability has changed.

   Registration for all Madison County course is now mandatory. Registration priority is given to County agencies, their regular mutual aid partners, then out of county students. It is the responsibility of the student to contact the fire coordinator if they have registered for a course and their availability has changed.

5. Name*

6. Email Address*

8. Phone Number*

9. Home Department*
   -- Select One --Brookfield FDBridgeport FDCanastota FDCazenovia FDChittenango FDDeRuyter FDEarlville FDEaton FDErieville FDGeorgetown FDHamilton FDHubbardsville FDLeonardsville FDLincoln FDMadison FDMorrisville FDMunnsville FDNew Woodstock FDNorth Brookfield FDNorth Chittenango FDOneida FDSmithfield FDWampsville FDOut of County (list in comments)

11. Select Course*
    -- Select One --Confined Space Awareness (Hamilton)Interior Firefighting Ops (Cazenovia FD)Trench Rescue Awareness (DeRuyter)Fire Office 1 - Module 1Fire Police (Chittenango FD)County Spring Seminar (Stockbridge High School)F/F Survival (Cazenovia FD)

12. Comments

14. Email List*

    1. Yes
    2. No

    Periodically, the Madison County Office of Emergency Management issues newsletters, press releases and other notifications. Do you give OEM permission to use your email address for notifications and announcements? Select Yes to accept, No to deny. Thanks.

Leave This Blank:


15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit Submit and Print

* indicates a required field