• 843.618.3181
  • info@prfd.com
  • 843.393.0209

Application

Application For Membership

Personal & Contact Information

Address *
Address
Street Address 1
Street Address 2
City
State/Province
Zip/Postal

Driver Information

Have you ever been convicted of any offense other than a minor traffic violation? *

Emergency Contact Information

Address of Emergency Contact *
Address of Emergency Contact
Street Address 1
Street Address 2
City
State/Province
Zip/Postal

Employment Information

Current Employer Address
Current Employer Address
Street Address 1
Street Address 2
City
State/Province
Zip/Postal

Previous Membership & Experience

Do you have any physical impairment that may interfere with your performance? *
Have you ever applied for membership? *
Have you ever been a member of any Fire/Rescue company? *

List Three (3) persons not related to you for references

Address
Address
Street Address 1
Street Address 2
City
State/Province
Zip/Postal
Address
Address
Street Address 1
Street Address 2
City
State/Province
Zip/Postal
Address
Address
Street Address 1
Street Address 2
City
State/Province
Zip/Postal

PLEASE READ AND SIGN

I hereby authorize Palmetto Rural Fire District, and its membership committee to investigate the statements made of this application. I will abide by the rules, regulations & by-laws set forth by Palmetto Rural Fire District. 

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We are the Palmetto Rural Fire District. Our department provides fire, rescue, and ems services.
Official info
  • Palmetto Rural Fire Dept
    1304 E. McIver Rd
    Darlington SC, 29532
  • Organization Phone 843.618.3181
  • Fax 843.393.0209
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