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.