Membership Application Personal Information: Name* Email* Street Address* Unit#/Apt# City* State* Zip* Date of Birth* Age* Driver’s License Number* Home Phone* Cell Phone* Sponsored & Known By: Length of Residency – Years* Length of Residency – Months* Marital Status*SingleMarried Blood Type Religion If you have any disabilities, please list them below. If none, enter N/A* Prior Experience: Do you have any prior firefighting experience?*NoYes If so where? Chief’s Name Phone Number E-mail Current Employment: Name of Employer How Long? Full Address Phone Work Hours Why do you want to join the fire company?* Type of Membership: Select membership class desired:*Class A – I understand I will have to obtain Fire Fighter 1 certification to become activeClass B – I will serve on committees and help with fundraising events Acknowledgement: Please Check read below and check the box to acknowledge:*I certify and acknowledge this information
