Fire Chief's Name *

First Name

Last Name

Please check all boxes that apply:

I have a SAFC Membership

We have a ¾ Tonne or larger Fire Truck that we will mount the skid on

We don’t have a Fire Truck to mount on but have a Municipal Truck to mount the skid on

We provide mutual aid and have written agreements in place with neighbouring Depts.

We do not have a wildland truck or truck mounted skid currently

We have a current wildland truck and skid but the skid needs to be replaced

We have a truck and skid, this new one would be a second unit to have capacity/backup

We have immediate need for a new skid

We are currently fundraising for a wildland skid ourselves

We will immediately put this unit into a truck and put it into service

Media Consent *

I acknowledge and agree to do on-camera videos and interviews as required to support SAFC and Global Medic when loading, receiving and installing the new skid. These videos will include thank you’s to Global Medic, the SAFC and will be posted on social media by the SAFC and Global Medic. I also acknowledge that I am authorized to accept a donation of a skid valued at $6000.00 on behalf of my Municipality.

Acknowledgement *

I acknowledge that the SAFC is only a conduit for distributing these skids and a MOU will be signed between Global Medic and my Department directly, holding SAFC harmless.