Beacon Mid-Atlantic | Membership Application

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Date of Birth *

Emergency Contact Name *

Emergency Contact Phone *

Address Information

Street Address *

City *

State *

ZIP Code *

Professional Background

Current Occupation *

Current Employer

Relevant Work Experience

Technical Skills & Certifications

Availability & Commitment

Are you able to participate in emergency deployments? *

Yes, I am available for emergency deployments

Yes, but with limited availability

No, I cannot participate in deployments

Availability Details

Can you commit to attending quarterly virtual meetings? *

Yes, I can attend quarterly meetings

Most of the time, with occasional conflicts

No, I cannot commit to regular meetings

Motivation & Goals

Why do you want to join Beacon Mid-Atlantic? *

Do you have any previous disaster response or volunteer experience?

What unique skills or perspectives would you bring to our team?

References (Optional but Recommended)

While not required, providing references can help expedite your application process.

Reference 1

Name

Relationship

Phone

Email

Reference 2

Name

Relationship

Phone

Email

Background Check Consent

All members must undergo background checks as required by their state of residence. This is necessary for our insurance and operational requirements.

I consent to a background check being performed as required by my state of residence and understand this is necessary for membership approval. *

I consent to Beacon Mid-Atlantic storing and using my personal information for membership purposes and organizational communications. *

Additional Information

Is there anything else you'd like us to know?

How did you hear about Beacon Mid-Atlantic?