LEBANON CO. ANIMAL RESCUE TEAM

MEMBERSHIP FORM

Please complete the following information if and when you are interested in becoming a member of LebCART. Also, be aware that it will be necessary for you to complete required online training (ICS and NIMS) as well as attending local training sessions prior to being permitted to assist with rescue operations.

  Last Name_________________________________ First Name_____________________              

Address_________________________________________________________________  

City____________________ County____________ State______________ Zip_________  

Phone (Home):____________ Cell:______________ Work_____________ Fax_________  

Organization Affiliation:______________________________________________________  

Title____________________ Email:___________________________________________  

Preferred Duties (Check all that apply):

            ¨ Administration          ¨ Disaster       ¨ Medical       ¨ Transport    

            ¨ Search & Rescue     ¨ Sheltering     ¨ Other (specify)  

Speciality (Check all that apply):

            ¨ Sm. Animal              ¨ Large Animal           ¨ Equine         ¨ Bovine

            ¨ Porcine        ¨ Livestock     ¨ Other (specify): __________________________ 

Equipment/Services:

Comments/Questions: