Fire Training Membership Application

Thank you for your interest in our fire training membership. This membership program is open to any in-county fire department or any out-of-county fire departments who are active participants in our annual per capita assessment. Completion of this application initiates the membership application process. Following the successful submission of this application and verification of your eligibility, your payment will be processed. Upon successful processing of your payment, your authorized representatives may begin scheduling classes through this program using our Training Membership Host Application. If you need to change your authorized representatives at any time during the program year, please contact us at info@fcpstc.org and inform us of the change(s).

Agency Information

Agency Name(Required)

Agency Mailing Address(Required)

Street Address City State ZIP Code

Agency Representatives

Personnel who are authorized to schedule training on behalf of department

Primary POC Name(Required)

First Last

Primary POC Phone(Required)

Primary POC Email(Required)

Enter Email Confirm Email

Alternate POC Name

First Last

Alternate POC Phone

Alternate POC Email

Enter Email Confirm Email

Billing Details

Payment Method(Required)

Check Enclosed (Please make payable to "Franklin County Public Safety Training Center")

Please Invoice the Department

Please Send a Quote to the Department

Financially Responsible Party?(Required)

Is your department the financially responsible party for your members?

Yes (Invoice my agency directly)

No (Invoice my relief association or other third party)

Financially Responsible Party Name

Enter the name of the financially responsible party (relief association, etc.).

Financially Responsible Party Street Address

Street Address Address Line 2 City State ZIP Code

Billing Point of Contact

Please enter the name of the POC for your financially responsible party

First Last

Billing POC Email

Please enter an email address for the POC for your relief association or other financially responsible party.

Enter Email Confirm Email

FCPSTC Fire Training Membership (Jan 1-Dec 31, 2024)

Annual training subscription - includes unlimited training hours for all Bucks County Community College courses hosted by the FCPSTC and 80 hours of on-site training at member's department.

Total

Hidden

Training Membership Program Terms and Conditions

Authorized Agent for Department(Required)
First Last

Authorized Agent Title(Required)

Authorized Agent Email(Required)

Authorized Agent Phone(Required)

Authorized Signature(Required)

Phone
This field is for validation purposes and should be left unchanged.