Santa Ana, CA · Orange County
Paramedic Subscription Program Enrollment Form
Santa Ana residents use this form to enroll themselves and permanent household members in the city’s paramedic subscription program.
What this form is
This form enrolls eligible Santa Ana residents in the city’s paramedic subscription program, which provides protection from the city’s paramedic and ambulance fees for the subscriber and enrolled permanent residents at the service address. The form asks for subscriber and address details, household members, and a signature and date. Enrollment requires a $76 check or money order; fees are non-refundable and non-transferable.
Who needs it
Santa Ana residents who want to enroll themselves and permanent household members at their service address in the paramedic subscription program need this form.
How to submit it
Mail the completed form with a $76 check or money order payable to City of Santa Ana; do not send cash. Mail both to City of Santa Ana, Paramedic Billing M-14, P.O. Box 1964, Santa Ana, CA 92702-1964.
About notarization
This document is signed and dated without a notary; it asks the subscriber to sign and date the form, and mentions no notarized or sworn attachment.
How to submit this form
- 1
Download The Form
Download the Paramedic Subscription Program Enrollment Form.
- 2
Complete The Form
Provide subscriber and address information, list additional permanent household members, and sign and date the form.
- 3
Prepare Payment
Include a $76 check or money order payable to City of Santa Ana. Do not send cash.
- 4
Mail The Form
Mail the form and payment to City of Santa Ana, Paramedic Billing M-14, P.O. Box 1964, Santa Ana, CA 92702-1964.
Frequently asked questions
- Who can enroll in Santa Ana’s paramedic subscription program?
- The subscriber must be a Santa Ana resident. The form also allows enrollment of permanent residents living at the service address; households outside the city are ineligible.
- How much does enrollment cost?
- The form requests a $76 check or money order payable to City of Santa Ana. It says not to send cash and that subscription fees are non-refundable and non-transferable.
- Do I need a notary for the Paramedic Subscription Program Enrollment Form?
- No. Sign and date the form; it mentions no notarized or sworn attachment.
- How do I submit the enrollment form?
- Mail the completed form with a $76 check or money order to City of Santa Ana, Paramedic Billing M-14, P.O. Box 1964, Santa Ana, CA 92702-1964. Do not send cash.