Join FireMed Click here for a Printable Enrollment Form

Please complete your information on each step. Fields with a red * are required fields. After reviewing your information on the Order Summary step, click ‘Confirm & Pay’ or correct any error message noted in red.
To change any item, go to the appropriate Step and make update. When finished, go to the Order Summary step, review, and click ‘Confirm & Pay’. A confirmation message will appear when the order is successfully submitted.

Choose which package you would like, or learn more about your membership options.

FireMed Basic

Ambulance

Full emergency ambulance coverage for your entire household.

$ 55
through 10/31/2019

FireMed Plus

Ambulance + Ambulance

Full emergency ambulance coverage for your entire household, plus Mercy Flights.

$ 99
through 10/31/2019

Passwords must be at least 6 characters long.




Include all persons who are primary residents of the same single-family occupancy, non-commercial residence, living together as a family unit, but not to include roomers or boarders.

Click the + sign to enter additional household members. If no other members apply, continue to next step.










Home Address (Residence):




Mailing Address:






FireMed Basic
$65.00

Total
$65.00

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