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Volunteer Member Time Card

  1. Instructions
    Use this form to record EMS shifts, the number of runs while on shift, Special Events and interfacility/airport transfers.
  2. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  3. Chief Signature and Date
  4. Leave This Blank:

  5. This field is not part of the form submission.