Welcome to the 2021 Fire Chiefs Summit 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 Michelle Fetterer at +1 847-423-5127 with any questions. We look forward to reviewing your application!

Event: 2021 Fire Chiefs Summit
First Name*
Last Name*
Your Title*
Department*
Name on Badge (if different from First Name)
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 population size does your department serve?

How many paid firefighters are in your department?

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

Are you a transporting agency?

Tell us about your department and the community it serves. (2-5 sentences)

Tell us about yourself and your role in the department. World traveler, pet owner, or cooking enthusiast? Tell us that, too! (2-5 sentences)

What is your department currently doing well?

What are some challenges your department is facing?

What questions would you ask your peers about their operations?

What other Fire Chiefs or Fire Departments would you recommend we include in the Summit?


PROCUREMENT PLANS:

What is your annual department budget?

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

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 and Supplies: What is your department's projected need?

EMS Equipment and Supplies: What is your department's projected need?

Protective Clothing and Apparel: What is your department's projected need?

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

Nozzles, Hoses, Reels and Couplings: What is your department's projected need?

Is your department planning to upgrade or add new training sites in the next 24 months?

What health and wellness programs are you implementing or interested in looking into for your department?

Please list 3-5 products or technologies you would like to learn more about. (Include specific companies, if any come to mind!)

Please give a little more detail about the above.

I Agree: If I am selected to participate in the Fire Chiefs Summit, I agree to be present for all sessions, meetings and functions scheduled for the event.

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