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Clinton Fire Department ID Tag Request Form
*
Indicates required field
Email
*
Name
*
First
Last
Member ID# 45-
*
Position
*
Select One
FIREFIGHTER
FF/RIC
FF/RIC/EMT
CHAUFFEUR
JR FIREFIGHTER
NON-INTERIOR
Emergency Contact Name
*
Emergency Contact Phone #
*
Blood Type
*
Allergies
*
ATTACH PHOTO - Head shot chest up against white wall
*
Max file size: 20MB
Quantity Needed
*
1 Tag
2 Tags
3 Tags
4 Tags
Submit
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