Please complete this application form if you are interested in becoming part of Austin / Travis County EMS Explorer Post 247. Once you complete the form, click the submit button at the bottom.

Contact Information

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Why are you interested in Austin / Travis County EMS Explorer 247 program?

Demographic Information

Please complete the following information.

Date of birth:

Age:

Gender:

Ethnicity:

High school:

College:

Emergency Contact Information

First name:

Last name:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

OK to call here

Cell phone:

OK to call here

Email address:

Relationship:

Email Preferences

We like to keep explorers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

What kinds of email would you like to receive?

Electronic newsletters

Recruitment appeals

Schedule reminders