New Member Registration Name* First Middle Last Rank*Agency*Agency Address (No PO Box)* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Agency Phone*FaxOfficer's Email Address* Your email address will be your user name.Last four digits of SSN*The last four (4) digits of your Social Security number. Example: (xxx-xx-0000)Password* Enter Password Confirm Password Please read over the linked Officer Agreement Form below and mark your agreement. Please print this form, fill it out, and send it to the WV LifeSavers office. WV Lifesavers Officer Agreement* I have filled out the WV Lifesavers Officer Agreement form and mailed a copy to the WV Lifesavers office.
