Become A Member

Type of Member
Full MemberAssociate Member - FireAssociate Member - MarineCadet (Must be 16)

Name

Your email

SS#

DOB:

AGE:

Gender: MaleFemale

Marital Status: MarriedSingle

Address:

Phone #:

How long at present address:

Emergency Contact:

Emergency Phone #:

Drivers License Info:
State:

Class:

Number:

Occupation:

Will your occupation allow you to answer fire calls day and night? YesNo

Do you have any physical infirmities that will prevent you from doing strenuous or hazardous work? YesNo

If Yes, please explain:

Our by-laws require a criminal background check. Have you ever been convicted of a felony?YesNo
If yes, where and when?

If elected, I promise to comply with all rules and regulations of Deal Island/Chance Volunteer Fire Company, Inc.
Signature

Date

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