FireWeb Membership Information

Show off your department to the world on the Internet's World Wide Web. Have a "Homepage" created with your department's name, statistical information, and a full color rendition of your patch and favorite apparatus. Either

Copy this form and email it along with your credit car information to Chief@fireweb.com
OR Print out this form, fill it out, and snail mail it and a check for $100 (made out to EEMC, Inc.) to:

FireWeb
c/o EEMC, Inc
4102 Buffalo Gap Road
Suite F-231
Abilene, Texas 79605-7243

Attach or Enclose

a scan of your patch,
a scan of a good color photo of your apparatus,

NOTE: If you don't have a scan of the patch or photo we can do that for you for a small additional fee.


Department Name ____________________________________________________

Area Served

Square miles: _____   # of stations: _____   Population: ______________

Largest percentage of area served, in square miles is (check one):

___Residential    ___Commercial   ___Industrial    ___Rural

Personnel:

Chief Name: __________________________________ Years in service: _______

# of Paid Professionals: _______  # of Unpaid Professionals (Vol): ________

Activity

Enter the number of runs in each category for the most recent  year:

Calendar year: ____________

Structure Fires: __________		Other Fires: __________

Rescues / Extrications			False Alarms and
Emergency Medical:     _______		System malfunctions: ________

Mutual Aid: _______			Other: ________

Haz-Mats: ________			Total Runs: __________

Apparatus:

# of Engines: ________

# of Trucks / Aerial Platforms: _______

# of Quads / Quints: ______

# of Med Units (if any): ______

# of Special Units
(Haz-Mat, Rescue, Other): ________

Select from the following files
Sound		Wallpaper Url: 
9MM		Select any background on any
aooo-gah	FireWeb page or supply us with one
CHIPS2		of your own
Cops
Dragnet51
Dragnet68
Emergency	
Emergency1	
Rescue911	
Twin Peaks	
Yesssss		
Dr. Who3		
Dr. Who 5

Describe your featured apparatus.  It can be your newest, oldest, 
cleanest, dirtiest, or most interesting.  Please limit your description 
to 500 characters.  There will be a separate page on the Web with a 
picture and description of your featured apparatus.

DON'T FORGET TO ENCLOSE A SCAN OF A GOOD COLOR PHOTO!  

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Contact Information:

How to contact your department for more information.  This information 
will be included on your Department Page ONLY if you request so by 
indicating below.

Name: ___________________________________________________________

Address: ________________________________________________________

City: ___________________________________________________________

State: ___________________   Zip: _______________________________

e-mail address: _________________________________________________


WANT A FIREWEB e-mail address? for only $15 a quarter we can provide
 one for you. Simply check this Block ______ , include the first year's 
payment with this form, and tell me what you would like the name and 
password to be here User name: ____________@fireweb.com;
 password___________; and your in business!

Phone: (_________)______________________________

FAX: (_________)____________________________

Which of the above information do you want included on your Department Page?

Check one:

______ Mailing address

______ e-mail address

______ none

Your department's 'Homepage' including featured apparatus , and Patch will be update within 2 work days from the receipt of this form. You will be sent verification of this, and provided with the 'URL' (electronic address) of your Department Page, so you and your members can view it and tell your friends and other departments about it.

Credit Card Information:
Type: Visa ___
MasterCard ___
Discover ___
American Express ___
Name as it appears on the front of the card:
Billing Address _______________________________________________
Card Number:_________________________________
Expiration date:______________________

Web page $100
Add Graphic No Charge
Add Sound No Charge
Add e-mail address $60
Total to be charged $

Forward any inquiries to:

Chief@fireweb.com 

FireWeb
^c/_o EEMC Inc.
4102 Buffalo Gap Road, Suite F-231
Abilene, Texas 79605-7243
(915) 793-0158