Orange County NC Website
Browse       Search
I <br /> ATTACHMENT 2 5 <br /> APPLICATION <br /> FOR <br /> AMBULANCE RESCUE OR MEDICAL FIRST RESPONDER FRANCHISE <br /> ORANGE COUNTY,NORTH CAROLINA <br /> Date of Application: October 7. 1996 <br /> I. APPLICANT: <br /> A. Name of Applicant: AMERICAN MEDICAL RESPONSE OF NORTH CAROLINA,INC- <br /> B. Address : Street : 1625 NAVAHO DRIVE <br /> City/State : RALEIGH,NORTH CAROLINA Zip :27609 <br /> C. Telephone No. at Base of Operations : 1-919-872-6682 or 1-800-366-8292 <br /> D. Name of Owner/Contact Person : KAREN WALLEY, CAPTAIN <br /> E. Address : Street : 1625 NAVAHO DRIVE <br /> City/State: RALEIGH.NORTH CAROLINA Zip :27609 <br /> F. Telephone No.: 1-919-872-6682 or 1-800-366-8292 <br /> G. *Trade Name : AMR <br /> H. Category of Franchise Applied For (A separate application must be completed for each category <br /> of service applied for) : <br /> BLS: ALS: RESCUE SERVICE <br /> ( ) First Responder ( ) D-Level ( ) Extrication <br /> ( ) Emergency Med. Techn. ( ) I-Level ( ) High/Low Angle <br /> (X) Convalescent Transport ( ) P-Level ( ) Confined Space <br /> ( ) Trench <br /> ( ) Water <br /> I. ATTACHMENTS REQUIRED <br /> 1. Certified copy of Articles of Incorporation Charter or*Assumed Name Certificate. <br /> SEE ATTACHMENT#1 <br /> 2. Resume' of training and experience of the applicant in rescue and transportation and care of <br /> patients. <br /> SEE ATTACHMENT#2 <br />