LVRS Contact Form

LVRS Contact Form

Please use this form to have someone from the Membership Committee to contact you about volunteering at Laurel Volunteer Rescue Squad.
Name: *

First Name Last Name
E-mail *
Phone Number *

- Area Code Phone Number
Type of Interest: *

EMS Fire/EMS
Are you 18 years old or older? *

Yes No
Are you interested in our live-in program? *

Yes No
Are you 16-17 years of age and interested in our cadet program?: *

Yes No
Best Method for Contact: *

Email Phone
Best time to contact *
Additional comments/Current Cerfitications
How did you find out about us? *

Google search/Company Website Referral Driving/Walking by the station Saw us on social media Community outreach event Other option
Were you referred to by a Current/Former Member? If so, please list their name:

First Name Last Name
Should be Empty:

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