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Information entered here will not be sold or given to outside agencies.  It is used solely for our use to ensure we provide
you the best information possible.  With the exception of the Fire Nuggets Newsletter, the only time you will receive e-mail
is if you indicate below that you wish to be apprised of Fire Nuggets sponsored vendor products, services and press releases.
 

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To help us serve you better, please tell us about yourself. Please answer all questions completely.

1. Are you a member of a fire department? 

  Yes  No


2. Rank or Title:

    

    If you select "Other", please specify:     


3. Volunteers or Paid:

    


4. Population Served by Department:

    


5. Departmental Function - SELECT ONE ONLY:

  Management
  Training
  Prevention
  Suppression
  Investigation
  Maintenance
Communication
Public Education
EMS
Hazmat
Rescue
NA
Other (If you select "Other", please specify:)


6. Are you involved with specifying, recommending or purchasing products/equipment for your department or organization?
 
  Yes  No


7. Additional Relationship to the Fire Service: SELECT ONE ONLY

  Other Government Department or Agency
  Industrial, Institutional, Military, Airport, High Rise or Other Organization with Special Fire Prevention or Suppression
  Fire Prevention and Fire Protection Engineering Firm, Fire Consultant Arson Investigation Organization, Insurance Company
  Fire Equipment Manufacturer
  Fire Equipment Distributor
  School
  Public Library
  Fire Association, Fire Museum, Publication, Radio, TV Station
  N/A
  Other

8. Yes, keep me apprised of Fire Nuggets sponsored vendor products, services and press releases?
 
  Yes  No

9. How did you hear about Fire Nuggets?

          
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