Join Today!

  • ALL Applications must be submitted online.
  • Payment is due at time of application.
  • This application process should take approximately 30-45 to complete.
  • Once your application is approved, you will a email with your.
  • To find out the status of your application, please email react@richmondcountyreact.org

IMPORTANT! Prior to starting the this online application, you should download and print the PDF copy of this application and fill it out completely . This is to ensure all questions in the online application can be completed. The online application can not be saved and will be discarded if not competed before submitting.

Download: ? Membership Application PDF

Richmond County REACT Membership Application Form
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First Name
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Last Name
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Gender
MaleFemale
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Date of Birth
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Mailing Address
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Country/Region
Country/RegionAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe
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Phone Number
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Driver's License / ID Card #
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Issuing State
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Vehicle Type (optional)
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Employer
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Time at Current Job
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Have you been convicted of any felony in the last 10 years?
No
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Have you been convicted of any misdemeanor in the last 3 years?
No
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Amateur Call Sign:
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GMRS Call Sign
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Do you have a Base Station Radio?
CB RadioGMRSMURSAmateur HFAmateur VHFAmateur UHFPlain Old Telephone
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Do you have a Mobile Radio?
CB RadioGMRSMURSAmateur HFAmateur VHFAmateur UHFPublic Safety
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Do you have a Hand Held Radio?
CB RadioGMRSMURSAmateur VHFAmateur UHFPublic SafetyLTE / CDMA Mobile Phone
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Medical Information
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List any allergies (include foods) :
YesNo
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If Yes, list allergies:
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Do you have any chronic illness or physical handicap?
YesNo
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If yes, explain:
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Are you willing to donate blood?
YesNo
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Blood type (if known):
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Doctor’s Name (optional):
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Doctor’s Phone # (optional):
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References
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Reference 1 - Name
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Reference 1 - Address
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Reference 1 - Phone #
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Reference 2 - Name
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Reference 2 - Address
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Reference 2 - Phone #
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Reference 3 - Name
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Reference 3 - Address
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Reference 3 - Phone #
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Other Information
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Do you belong to any other club or organization?
YesNo
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If Yes, please list:
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Have you ever served in the military?
YesNo
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If yes, list Branch, Rank, and duties:
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Have you previously been a member of a REACT team?
YesNo
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If yes, list prior team # and reason for leaving:
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Were you recommended by a member of this REACT team?
YesNo
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Statement of Facts
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I do hereby agree to abide by all rules and regulations set forth in the monitoring guide and the Constitution and Bylaws of Richmond County NY REACT Team #6269, Inc. I understand that upon my voluntary resignation or dismissal for cause from this organization I will be obligated to return to the organization, within seven (7) days, all items which are the property of the organization, including but not limited to those which bear any officially recognized REACT International or Richmond County REACT Team identification.
Yes
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I hereby agree to all provisions of this application, and attest that all information contained herein is true and correct.
Yes
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Website Login
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Username
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Email Address
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Password
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    Strength: Very Weak
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