David Clark Biannual Headset System Giveaway – Entry Form

David Clark Biannual Headset System Giveaway – Entry Form

Please fill out all the information contained in the Entry Form below. Once you submit the form, your department will be qualified* for a chance to win a David Clark Headset System designed specifically for your selected apparatus and communication needs. Thank you for all that you do, and good luck!

* Please also review the David Clark Headset Giveaway Guidelines section

Application

Name *
Title *
Email *
Phone Number *
Chief's Name (if person applying is not the chief)
Chief's Email
Department Name *
Department Street Address *
Address Line 2
City *
State/Province/Region *
Postal/Zip Code *
Country *
Department Phone Number *
Number of active VOLUNTEER firefighters in department? *
Number of active PAID firefighters in department? *
Indicate the level of training required for firefighters in your department, eg. Firefighter 1, Firefighter 2, etc. *
Area Served (approx. square miles) *
Population Served *
Average number of annual calls *
Has your department ever used or does it currently use any brand or type of headset communication intercom system? *
Choose from the selection below.No, we have not used a headset communication system on a apparatus.Yes, we have tried a headset communication system in the past.Yes, we currently use a headset communication system on one or more pieces of apparatus.
If "Yes" to either question above, please provide the name of the headset communication system manufacturer
Apparatus/Radios *
Describe the apparatus in which you’d like to have the system installed (e.g. pumper, aerial, fire boat, etc. and include number of positions, radio type(s) and make/model of two-way radios used for communication).
Describe Your Communication Needs *
Tell us about your communication needs and challenges (en route and at the scene). Be as specific as possible. How do you think a David Clark Headset System would help overcome these challenges?

Verification

Please enter any two digits *Example: 12
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By submitting this entry from, you agree to the terms and statements outlined in the Giveaway Guidelines section of this website.