DIRT APPLICATION D.I.R.T. ApplicationFill out form completely. Your Contact InformationFirst Name: *Last Name: *D.O.B.*Phone*##########Email*Current shift assignment at CCEMSAre you currently certified in the following: Check all that apply SAR Tech SCUBA Diver Swiftwater Rescue TechPlease list any disciplines you are interested in, such as swift water, diving, logistics, etc...*Please attach a photo of yourselfFor questions or more information, contact Chad WardChad.Ward@ccems.org304-690-1466 Please enter the security code: Security Code:Please enter a valid captcha code. Submit Submit
