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APPLICATION <br />FOR <br />nMB[JLANCE RESCUE OR h~DICAL FIRST RESPONDER FRANCHISE <br />ORANGE COUNTY, NORTH CAROLAIA <br />z <br />Dme ofAppRCauov: luly 13. 1998 <br />I. APPLICANT: <br />A Name ofAppgcen[ Omvge Ravel Fve Depedment <br />B. Address:Street: 2o35omh Chuwn So-em <br />Ciry/Store: HiRSborough, NC ZIP: 2]2]8 <br />C. Telephone NO.mBase ofOperefiovs: 919-]324911 <br />D. Name ofOxmer/COemct Person: IeffCabq Chief <br />E. Address:Stree[: Same <br />Ciry/State: Same Zip: Same <br />F. Telephone No.: Same <br />G. 'Trade Name: <br />H. Ca4gory ofFmvchise Applied For (A Sepamm appEwdon mus[be wmpktN <br />for each category of service appBed for): <br />BLS: ALS: RESCUE SERVICES <br />[ I] Fim Reapovdn I 1 D-Level ( ] Extriceaov <br />[ I Emmgency Mad Techn [ ] [-Level [ ] High/Low AVgk <br />[ ] Cwveleswm Tmvaporl [ ] P-Level [ ] Covfmd Space <br />[ I Trench <br />[ ]wear <br />I. ATTACHMENTS REQUlltED: <br />1. Cerrified wpy otArticles of lnwryomaon Chmur or 'Assumed Neme <br />Cvefiraro. <br />2. Rnume'ofaaivivg and experience ofthe eppEcmtNrescue and <br />aavspormdm end core ofperievts. <br />3. A fimvdel s[e4ment az it peruws m opaatlovs m Orange Couvry. <br />4. Awpy ofOrgevvedon's By-Laws (ifappEwble). <br />5. Awpy ofOrgevivdoa's Smvderd Opemuvg Pmc~mn. <br />6. Acunmtresser ofinembmmivclude more, address, and <br />s«iel secaity number. <br />