South Lane County Fire & Rescue: FireMed Application

Enter primary member/head of household information here.

First Name(*)
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Last Name(*)
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Please list other household members, if any. Include the totals number of household members living at this residence to be covered by the FireMed Membership. If you are the only member of the household, please indicate this by selecting "1" as the total number of household members.

Number of Household Members. (*)
Please tell us how many family members live in your household.

Number of household members.

Household Member 1
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Household Member 2
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Household Member 3
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Household Member 4
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Household Member 5
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Household Member 6
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Household Member 7
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Insurance Information (optional)

Primary Insurance Company
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Insurance ID Number
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Please select a FireMed Membership Level. Payment is by Secure Credit Card processing by PayPal (no PayPal account required).

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Ground Ambulance Only is $65 per year. Ground Ambulance + Air Transport is $110 per year. Life Flight Air Ambulance Only is $65 per year.

Total (Pay by Credit Card)
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When you click "submit," you will be redirected to PayPal for secure credit card processing. No PayPal account is required. You will receive an email confirmation of your application and payment once payment is processed.
  

Contact Us

Administration and Headquarters
233 Harrison Ave
Cottage Grove, OR 97424
tel: (541) 942-4493
fax: (541) 942-3367

Business Hours: 8 am to 5 pm Mon-Fri

Emergency Dial 911

FireMed: Join Today!

FireMed LogoA ground ambulance transport in the Eugene-Springfield area will cost more than $1,800, and an air ambulance more than $18,000, unless you have FireMed! Health insurance may cover 20-50%. FireMed members pay NOTHING, even if they have no insurance, and your membership covers your whole household. Learn more...