Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Which sessions do you plan on attending? *Command OfficerCompany OfficerSponsoring Agency InformationPlease tell us a little bit about the agency that is sponsoring you to join us at the 2025 NVRFI LDI.Sponsoring Agency Name *Please provide the Agency sponsoring your attendance.Sponsoring Agency FDID # *Sponsoring Agency Organization Type *CareerCombinationVolunteerPlease select your sponsoring agency’s organizational typeYour role within your Sponsoring AgencyPaid Full TimePaid Part TimeVolunteerAgency Representative and AddressPlease provide your primary agency billing representative and address. Only required for those outside the Northern Virginia Emergency Response System.Your ExperiencePlease tell us a little bit about your experience in the Fire/Rescue/EMS industries.Current Rank/Position *Current rank or position held within your sponsoring organization.Number of Years in Current Rank or Position *Number of years of expereince *Number of years of career experience *Number of years of volunteer experience *Other Experience *Please list any Fire/Rescue/EMS experience you had outside of your sponsoring organization. If none, please say none.Contact & AccomodationsPlease provide your contact details and any accommodation needs.Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Do you have any Limitations or Require any Special Accommodations? *NoYesFood Allergies, Limiting Preferences, DisabilitiesSpecial AccomodationsPlease provide details for any limitation or Special AccommodationsShirt Size *SmallMediumLargeX-Large2X-Large3X-Large4X-LargePlease provide your shirt size.Approval Form and ResumePlease upload your Sponsoring Organization Approval Form and your Resume. The Sponsoring Organization Approval Form can be found: https://www.novaldi.us/wp-content/uploads/2025/05/2025-LDI-Sponsoring-Organization-Approval-Form.pdfSponsoring Organization Approval Form * Click or drag a file to this area to upload. Resume * Click or drag a file to this area to upload. Comments or QuestionsSubmit
