Official Website of the

Ridgefield Park Volunteer Ambulance Corp

Administrative Officers

Silvio Zapata

President

Ricardo Poli

Vice President

Ibraheem Yanes

Treasurer

Jane Lee

Secretary

Randall Koch

Chaplain

Operational Officers

Amanda Thomas

Chief

1st Assistant Chief

John Weidner

2nd Assistant Chief

Amanda Djamoos

3rd Assistant Chief

Edwin Hernandez

Mechanic

Life Members

Maria Beltran

Linda Betley

Al Brooks

Michelle Cappasso-Slatery

Edwin Coyle

Raymond Dwyer

Thomas Farrell

Joseph Fiore

Sean Florio

Louis Guyre

Stephanie Hansen

William Hansen Jr.

Robert Hofmeister

Lorraine Kenny

Georgios 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

Steven Poli

Raymond Pomperi

Edward Rose

Ryan Rottner

Thomas Ryan

Joe Samus

John Saus

Marjory Taylor-Henderson

Mary Touchette

Ronald Wagner

Samuel Yellen

Life Active

Richard Brown

Kevin Coyle

Steven Fernandez

Orestis Kotzias

Hugo Poli

Irma Rutkowski

Mariann Spontak

John Tymon

Senior Members

Christian Adams

Military Leave- U.S. Army

Jessamyn Alvarado

Parag Badami

Raul Camilo

Jenice Diaz

Karlie Formoe

Military Leave- U.S. Coast Guard

Christine Lowe

Alex Marlowe

Dawn Moylan

Chelsea Nagurka

Jacqueyn Quaglino

Military Leave- U.S. Army

Jacob Schwartz

Margaret Sellen

Joseph Sheehan

Nechama Tave

Military Leave- Israel Defense Forces

Andrew Valenzuela

Kyle Viola

Probationary Members

Ariana Basdeo

Kevin Bayhon

Nick Blake

Military Leave- U.S. Navy

Dylan Moylan

Liscary Pacheco

Hennesys Perez

Associate Members

Daman Ahluwalia

Sean Kiley

Youth Members

Luiza Tinaj

Reserve Members

John DeJesus

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.