Family Membership

A family membership covers the primary member and other household members listed on the application for a period of one year against out-of-pocket expenses that might otherwise be incurred from emergency ambulance transport by Medstar Ambulance.

For families of six or more or for group memberships, please call (707) 462-3808.

You may also download and print our Membership Application, if you'd like. Simply complete and mail with payment.

Price: $65.00
Full name of the primary applicant.
Primary applicant's date of birth in mm/dd/yyyy format.
Street address of your residence or place of business within Medstar's response area.
Mailing address, if different than physical address above.
Full name of the second family member.
Date of birth of the second family member in mm/dd/yyyy format.
Relationship of the second family member to the primary applicant.
Full name of the third family member.
Date of birth of the third family member in mm/dd/yyyy format.
Relationship of the third family member to the primary applicant.
Full name of the fourth family member.
Date of birth of the fourth family member in mm/dd/yyyy format.
Relationship of the fourth family member to the primary applicant.
Full name of the fifth family member.
Date of birth of the fifth family member in mm/dd/yyyy format.
Relationship of the fifth family member to the primary applicant.