AMBULANCE MEMBERSHIP

Why should you be a subscriber if you have Medicare of other insurance?

Subscribing to Glen Rock EMS, Inc. is valuable. We will third party bill your insurance or Medicare, however, there is typically a remaining balance left over. With your subscription, we will only bill you for 50% of the remaining balance.

Glen Rock EMS, Inc. will cover the other 50%. Your subscriptions and donations also provide a major source of our annual income so we can be ready to respond to your emergency!

Cost of Average Ambulance Transport - $1000
Average Ambulance Reimbursement - $600
Balance Due to Glen Rock EMS, Inc. - $400

BECOME A SUBSCRIBER...
You now pay 50% of the balance - $200
Non Subscribers have to pay $400

SUBSCRIBE TODAY!

Please complete the form below to subscribe! Please do not forget to select whether you are mailing a check or paying on-line!

CHOOSE YOUR SUBSCRIPTION TYPE:

Primary Subscription Contact (your name):

MEMBER ID (located on your mailer)

If a FAMILY SUBSCRIPTION or a SR COUPLE, please list all names this covers in your household on one line separated by a comma and a space!

Address:

City, State, Zip

Phone Number:

Email Address:

Will you be mailing a check or using the payment portal below for your subscription?

Mailing Check
Paying On-Line

General Donation Amount $

Total Donation $

* required field

Please complete the item(s) outlined in red.

MAIL IN CHECK OPTION
If you selected "mailing a check", please remit payment by sending a check to:
Glen Rock EMS
59 Water Street
Glen Rock, PA 17327