Membership Application / Renewal Process Checklist
Checklist for RAC-R FY 2027 (09/01/2026 – 08/31/2027)
Complete Membership Application and Registration Form
*
Completed and signed
Read Membership SOPs and By-Laws (available at www.rac-r.com)
*
I have read the documents mentioned above
Read and sign Member Responsibility Review
*
Read and Signed
Read and sign Member Attestation for all Regional Plans
*
Read and Signed
Pay dues
*
Paid
To be paid at a later date (due no later than November 13, 2026
(EMS Only) Complete Affidavit Acknowledging Utilization of RAC Regional Protocols Regarding Patient Destination and Transport, and the Adult Trauma Pre-Hospital Triage Guidelines.
*
Read and Signed
NA- not and EMS service
Name
*
First Name
Last Name
Signature
*
Date
*
-
Month
-
Day
Year
Date
Email to submitter
*
example@example.com
Return all documents via email to racrinfo@rac-r.com.
Submit Checklist
Should be Empty: