Welcome to the Fire Chiefs Summit 2017 Grant Application

Please complete the below form to apply for the Summit. Make sure to complete the entire form and then click the blue "Continue" button. Please feel free to call Katie Sieracki at 847-423-2991 with any questions. We look forward to reviewing your application!

Event: Fire Chiefs Summit 2017
User Name*
Choose a Password*
Please retype Password*
First Name*
Last Name*
Your Title*
Company*
Name on Badge*
E-Mail*
Confirm E-Mail*
Work Address*
City*
State (two-letter abbreviation)*
ZIP/Postal*
Work Phone Number*
Cell Number*
Emergency Contact Person AND Phone Number*
 
To verify that you're a real human and not an automated spambot, please answer the following question:
Independence Day is the Fourth of*
 
*These fields are required to have a value.

Please tell us about your organization:

What's the population size for which your department serves?

How many paid and/or volunteer firefighters are in your department?

How many EMTs and/or Paramedics are in your department?

Tell us a little about your department:

Tell us a little about yourself - your background, years in the industry and your current scope of responsibility. Hunter, fisherman or muscle cars? Tell us that too!

What do you think your department is doing well right now?

What keeps you up at night regarding your department?

Who are some professionals in the industry you would enjoy spending time with?

If you could ask a room full of your peers a question or two about their operations, what would it be?

What is your annual department budget?

Are you responsible for the selection or recommendation of products and services for your department?


PROCUREMENT PLANS: For which of these will your department be planning a purchase?

New fire vehicles: What is your department's projected need:

New EMS vehicles: What is your department's projected need:

Communications Equipment: What is your department's projected need:

Facility Construction or Retrofit: What is your department's projected need:

Incident management and accountability systems: What is your department's projected need:

Breathing apparatus / Air Systems / SCBA & Supplies: What's your department's projected need for any of this apparatus?

EMS equipment & supplies: What is your department's projected need:

Protective clothing and apparel: What is your department's projected need?

Nozzles, hoses, reels and couplings: What is your projected need:

Hand Tools & Forcible Entry: What is your department's projected need:

Other products or technologies you're interested in learning more about:

Please give a little more detail about this area:

What is the name and title of your immediate supervisor?

What's your shirt size?

I Agree: If I am selected to attend the Fire Chiefs Summit, I agree to be present for all sessions, meetings and functions while at the event.

Please Enter a short Bio. If selected, this will be printed in the Summit guidebook.

Please only click the "continue" button once. The application will take a moment to process your responses.