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2. 
3. Membership Interest Form

   Submit this form and we will follow-up with you to answer any questions you have about becoming part of our firefighting or Emergency Medical Services (EMS) team with Grafton Fire Department. This is not an application, simply a request for more info.

5. First Name*
6. Last Name*
8. Address1*
10. Address2
12. City*
13. State*
14. Zip*
16. Telephone*
18. Email*
22. Do you live in Grafton?*

    1. Yes
    2. No
23. If no, do you plan to move to Grafton?

    1. No
    2. Yes, within the next 3 months
    3. Yes, within the next 6 months
    4. Yes, within the next 12 months
    5. Yes, but not sure when
27. Do you work in Grafton?*

    1. Yes
    2. No
28. If yes, will your employer let you leave for calls?

    1. Yes
    2. No
    3. Not sure
32. Fire/EMS Experience*

    Do you have any previous firefighting or EMS experience? (Note: Experience is not required for Paid-on-Call positions)

    1. Yes
    2. No
34. If yes, please explain:

    Leave blank if you answered "No".

    Please list any certifications and/or years of experience.

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field