Pewamo, MI · Ionia County
Portland Ambulance Emergency Care Plan Membership Application and Agreement
This application and agreement lets eligible households enroll in Portland Ambulance’s Emergency Care Plan for medically necessary ambulance services during the 2026–2027 coverage year.
What this form is
Households residing in Portland Ambulance Service’s coverage area can use this application to enroll or renew membership for medically necessary ambulance services from July 1, 2026, through June 30, 2027. The form asks for household and insurance information, copies of current insurance cards, and signatures. The annual membership fee is $75, and the application, payment, and insurance-card copies must be submitted by the enrollment deadline.
Who needs it
Households in Portland Ambulance Service’s coverage area that want to enroll in or renew the Emergency Care Plan need to complete this application.
How to submit it
Submit the completed form, payment, and copies of all current insurance cards to City of Portland, Attn: Emergency Care Plan, 259 Kent St, Portland, MI 48875.
About notarization
This document is signed without a notary; the head of household and spouse, if applicable, sign and date the agreement, and no notarized attachment is listed.
How to submit this form
- 1
Download the Application
Download the Portland Ambulance Emergency Care Plan Membership Application and Agreement.
- 2
Complete the Form
Provide household and insurance information, indicate whether this is a renewal, and sign and date the agreement.
- 3
Gather Required Items
Include payment and copies of all current insurance cards.
- 4
Submit to the City
Send the application and required items to City of Portland, Attn: Emergency Care Plan, 259 Kent St, Portland, MI 48875.
Frequently asked questions
- Who can enroll in the Portland Ambulance Emergency Care Plan?
- Any household residing in Portland Ambulance Service’s coverage area may subscribe, regardless of financial status or insurance coverage. The form defines a household based on persons claimed on the enrolling member’s prior-year federal tax return.
- What must I include with the application?
- Submit payment and copies of all current insurance cards with the completed application. The form lists an annual membership fee of $75.
- Do I need a notary for the Portland Ambulance Emergency Care Plan application?
- No. This document is signed without a notary. The head of household and spouse, if applicable, sign and date the agreement; no notarized attachment is listed.
- How do I submit the Portland Ambulance Emergency Care Plan application?
- Send the completed form, payment, and copies of all current insurance cards to City of Portland, Attn: Emergency Care Plan, 259 Kent St, Portland, MI 48875.