Audiotech's Partnership Program

Fire Department Profile Registration Form

 

Directions: Fire departments that would like to be considered in the partnership program for the donation of a new siren controller should fill out the form below. This information is used by our staff in assisting donors in placing new siren controllers at stations that need them.

Please note that due to the large number of requests we receive, we cannot guarantee that every registered department will receive a siren controller through this program. Eligibility is determined in the following manner at the request of the donor:

1.  Donation is made to a specific fire department chosen by the donor;

2.  Donation is made to a fire department in a geographical region specified by the donor;

3.  If no department or region is specified, then donation is made to a department in a first-come, first-serve basis, determined by when their on-line registration form is received by Audiotech.

Please complete the form in its entirety. Incomplete forms cannot be processed. If you have any questions, please e-mail us, and we will be happy to assist.

PART ONE:  Basic Information

Your name:

Title: 

Company or Dept. 

Address 

Address 

City       State 

ZIP Code 

Township        County 

Phone   Fax     

E-mail 

Siren Type 

How did you hear about us? 

PART TWO:  Publicity

We would like to submit a news article to your local newspapers about the program. Please provide us with the name(s) of the most popular papers in your area

1.

2.

3.

If you feel that there are any extenuating circumstances regarding your old siren controller that would be newsworthy, please describe it here

Lastly, do you feel that there are any local residents or businesses that would be in a position to donate a controller to your department? If so, and ONLY if you feel it's appropriate, please fill in the fields below and we'll contact them about the partnership program and the tax benefits that they can receive by helping you out.

1. Name

1. Phone

2. Name

2. Phone

That's it! Take a moment to review the form and when you're satisfied that everything is correct, click the SUBMIT button below.