Register an Organization

Please review this list of registered organizations carefully. If your organization is already listed, do not complete this form.
Register a New Organization
If you organization is not listed above, please register your organization. Please note: Only designated administrators should register their organization.
Organization Type*
Organization Name*
Primary Phone Number*
Secondary Phone Number
Fax Number
Mailing Address*
Mailing Address Line 2
City*
State*
Zipcode*
Organization Email
Primary Contact*
Secondary Contact
Jurisdiction*
EIN Number
Membership
Number of Members
Volunteer
Career
Number of Active Firefighters
Volunteer
Career
Number of Active EMS Personnel
Volunteer
Career
Administrator Membership Information
Please fill out the form below in it's entirety. It will enable you to log in to the membership portion of this website. It will also allow you to make future updates to this Organization data.
Name*
First Last
Username*

Please create a user name. It will be used to login to the website.
Password*
Enter Password Confirm Password

Strength indicator

You must create a STRONG password as is indicated by the strength meter above. It should be at least 9 characters in length and contain upper and lower case letters, numbers, spaces and/or symbols.

HINT: Simple sentences with spaces and punctuation are excellent passwords.
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Primary Phone Number*
Secondary Phone Number
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

Register a New Organization

Membership

Administrator Membership Information

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