Official Website of the

Ridgefield Park Volunteer Ambulance Corp

Administrative Officers

Silvio Zapata

President

Georgios Kotzias

Vice President

Zach Vorisek

Treasurer

Jane Lee

Secretary

Randall Koch

Chaplain

Operational Officers

John Weidner

Chief

Edwin Hernandez

1st Assistant Chief

Chelsea Nagurka

2nd Assistant Chief

Joseph Sheehan

2nd Assistant Chief

Raul Camilo

3rd Assistant Chief

Life Members

Christian Adams

Jessamyn Alvarado

Maria Beltran

Linda Betley

Al Brooks

Richard Brown

Michelle Cappasso-Slatery

Kevin Coyle

Raymond Dwyer

Thomas Farrell

Steven Fernandez

Joseph Fiore

Sean Florio

Louis Guyre

Stephanie Hansen

William Hansen Jr.

Robert Hofmeister

Lorraine Kenny

Orestis Kotzias

Claire Kubler

Tim LaTour

Roy Lazzaro

Patricia Loney

Jane Lowe

Mary Jane Lutz

Dan Manaut

Walter Mastison

Gigi Mauder

Dawn Nicholas

Joseph Nolan

Tom Opperman

Ricardo Poli

Raymond Pomperi

Edward Rose

Ryan Rottner

Irma Rutkowski

Thomas Ryan

Joe Samus

John Saus

Jacob Schwartz

Margaret Sellen

Mariann Spontak

Marjory Taylor-Henderson

Amanda Thomas

Mary Touchette

John Tymon

Ronald Wagner

Samuel Yellen

Senior Members

Parag Badami

Kira Chontow

Jenice Diaz

Karlie Formoe

Military Leave- U.S. Coast Guard

Alex Marlowe

Dawn Moylan

Kyle Viola

Abdulwahhaad Yanes

Treasurer

Probationary Members

Ariana Basdeo

Nick Blake

Military Leave- U.S. Navy

Dylan Levy

Dylan Moylan

David Vasquez

Associate Members

Daman Ahluwalia

Sean Kiley

Everlyn Zamora

Reserve Members

Andres Faciolince

Pearlene King

Rose Wellens

Volunteer

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Membership Class

Applicant Details

First Name

Last Name

Cell Phone

Home Phone

Address Street

Address City, State, Zip Code

Date of Birth

Driver's License Number

Driver's License Issued State

Driver's License Expires

Current Employer

Employer Phone

Employer Address Street

Employer Address City, State, Zip Code

Emergency Contact Details

Contact First Name

Contact Last Name

Contact Phone

Contact Address Street

Contact Address City, State, Zip Code

Second Emergency Contact Details

Second Contact First Name

Second Contact Last Name

Second Contact Phone

Second Contact Address Street

Second Contact Address City, State, Zip Code

Applicant Details Continued

Do you have any physical limitations or illnesses that would preclude you from performing the duties of emergency medical services?

HAVE YOU EVER BEEN A MEMBER OF A VOLUNTEER AGENCY BEFORE?

IF YES, WHERE AND WHAT DATES? LIST ANY RPVAC MEMBERS WHOM YOU KNOW.

HAVE YOU EVER BEEN CONVICTED OF ANY CRIME?

IF YES, PLEASE EXPLAIN.

PLEASE LIST ANY MOVING VIOLATIONS THAT YOU HAVE HAD IN THE PAST 18 MONTHS.

PLEASE LIST ANY ACCIDENTS THAT YOU HAVE HAD IN THE PAST 3 YEARS.

I hereby authorize inquire by the Corps of all statements contained in this application and release those individuals from any and all liability and damage resulting from or arising out of such investigations. I understand that any misrepresentation or omission of facts in this application is cause for immediate dismissal from the Corps.

I consent to taking a pre-membership physical exam and such future exams as may be required by the Corps. I agree to comply with all rules and regulations and by-laws governing the corps, and further agree to return any and all equipment and/or clothing loaned to me by the corps upon relinquishing my membership in RPVAC.

I hereby declare that all the above statements are true.