Glendale Medic Program - Residents

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For more information, click here to view/download brochure.

If you have additional questions regarding this program please call (818) 548-4041.

Please make all checks payable to the City of Glendale. Thank you!

Please correct the field(s) marked in red below:

Please fill out this application and mail to:
Glendale Fire Department GLENDALE MEDIC Program
421 Oak Street
Glendale, CA 91204-1298
Or fax to (818) 409-7111
Questions? Call (818) 548-4041
1
Last Name
 *
2
Middle Initial
3
First Name
 *
4
Street Address
 *
5
Apt. or Unit Number
 *
6
Zip Code
 *
7
Telephone
 *
8
GWP Account Number to be billed
I authorize the Glendale Fire Department to bill my GWP account as indicated above, ($60 per year) for membership in GLENDALE MEDIC. I understand the GFD will bill any insurance that I or any covered member of my household may have. I agree to immediately forward any payment received to the Glendale Fire Department. Coverage begins the day we receive your application. I will reapply for membership if I move within Glendale.
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