Bullard Turtle Club - Registration

Turtle Club Registration

"*" indicates required fields

Proposed By*

Title*

Email Address*

Company Name*

Phone Number*

Street Address

City

State

Zip Code

Because

Name

escaped serious injury by wearing a "hard hat" at the time of an accident, I hereby make application for his/her membership in the Turtle Club.

Date of Incident*

Place of accident (City, State Zip)*

Please provide your best description of what happened in the incident and how a Bullard Thermal Imager helped these firefighters save a life.*

Hat or cap manufactured By*

Approximate age of hat or cap*

Additional Comments

Please send:

ADVENT® industrial helmet with Turtle Club insignia

Conventional hard hat with Turtle Club insignia

Certify

I hereby certify the statements made above are true in every detail

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