Subscription Application

Our annual EMS insurance program is also our grassroots fund raiser

Northshire Rescue Squad Subscription Application

For a $110 fee, all expenses incurred for use of our services, by you or any member of your household, will be covered - with no cost to you - from August 1, 2021 through July 31, 2022.

Please fill in all Principal Member information below.  If you have other household members, fill in a Name and Date of Birth for each in the Other Household Members section.  After submitting the form, you will be taken to a secure PayPal site for your payment information.

Principle Member

Other Household Members

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