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: