Palouse Clearwater Search and Rescue Membership Application

Applications for membership are approved by the general membership. An applicant may be elected to membership at his/her third regular membership meeting. 

Membership requires that you meet and maintain conditions documented in the unit's by-laws and standing rules published separately. To begin the application procedure, please supply the information requested below, and sign to indicate your understanding and acceptance of the conditions.

PLEASE PRINT NEATLY!!

Your LEGAL name (as on your driverís license): LAST, FIRST, MIDDLE INITIAL

      __________________________________________________ 

An alternate name by which you wish to be known and listed as in rosters. (i.e. Gerald Smith = Jerry Smith):

        ________________________

Your email address:

        ____________________________________________________

Your phone number:

        _____________________________________

Your mailing address (so we can send US mail to you):

        ______________________________________________________________________________

(Street, apartment, P.O. Box...) (City) (State)

Your current physical (street) address (so we know where to drive to give you a ride, etc.):

          ________________________________________________________________________

(Street) (City) (State)

Other Addresses (Work, Home, Second HomeÖ.) Other Phone #ís (Work, Cell, Pager)

______ _______________________________________________ ________ (________)________________

Type Street City State Type

_______ ____________________________________________________ _________ ____________________________

_______ ____________________________________________________ _________ _____________________________

First Aid certification level:___________, Expiration Date_______________________

Please list any special skills and training below your signature. That would include things like advanced medical training, radio operations (amateur radio license), rope skills, tracking, SCUBA, dog handling, extreme mountain biking, water rescue, ICS/NIMS, etc.

I apply for membership in Palouse Clearwater Search and Rescue and agree to meet the requirements described in the by-laws and standing rules.

 

Signature_________________________________________________ Date:__________________________

PCSAR Application 10/11/2018