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Medic Standby Request
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This form is only to be used by agencies who have contracted with the fire department for medic standbys. *Information submitted on this form will be sent via email. To protect sensitive information, do not include the following information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, and passwords.
Indicate the date and time that this request is being made.
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Please include the first and last name of the contact person for this request.
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