Northshire Rescue Squad

EMERGENCIES

SQUAD OFFICE

DIAL 911

(802) 362-1995

Serving the Northshire since 1964

Subscription Application

Our annual EMS insurance program is also our grassroots fund raiser

Manchester 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, 2017 through July 31, 2018.

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.

Principal Member

Other Household Members

Name: Enter Name

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Email: Enter Email

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Address: Enter Address

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City: Enter City

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State: Enter State

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Zip code: Enter Zip

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Home Phone: Enter Phone Number

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Date of Birth: Enter Date of Birth

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Name 2: Enter Name (Member 2)

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Date of Birth 2: Enter Date of Birth (Member 2)

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Name 3: Enter Name (Member 3)

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Date of Birth 3: Enter Date of Birth (Member 3)

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Name 4: Enter Name (Member 4)

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Date of Birth 4: Enter Date of Birth (Member 4)

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Name 5: Enter Name (Member 5)

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Date of Birth 5: Enter Date of Birth (Member 5)

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Name 6: Enter Name (Member 6)

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Date of Birth 6: Enter Date of Birth (Member 6)

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Control your cost

Emergencies happen

Support your community

The Subscription Program is all about controlling the cost of emergency medical services.

We hope you don't need our services - but if you do - the Subscription Program covers 100% of your cost.

Each year we respond to over 1200 emergency calls in the Northshire. Help us serve the community by joining the Subscription Program today!

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