VOLUNTEER FIRE DEPARTMENT MEMBERSHIP APPLICATION
(Please print, fill out, and mail to the address listed below!)
| Name: __________________________________________________ Address: __________________________________________________  __________________________________________________ Telephone: ______________________________ Work #: ______________________________ Cell #: ______________________________ Social Security #: ______________________________ Date of Birth: ______________________________ Any Health issues that you are aware of: ________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Office Use Only: Received by: ______________________________ Approved by membership: ______________________________ Chief Signature: ______________________________ Clerk Signature: ______________________________ |