MEMBERSHIP APPLICATION

 

JUNIOR FIRE-FIGHTER TIOGA FIRE COMPANY NO. 1. INC.

 

ANY MISREPRESENTION OR FALSE STATEMENTS ON THIS APPLICATION OR PERSONAL DATA WILL LEAD TO AUTOMATIC REJECTION OR DISMISSAL. (ALL APPLICANTS WILL BE INVESTIGATED) AN APPLICATION FEE OF $3.00 PLUS $1.00 DUES, A TOTAL OF $4.00, MUST ACCOMPANY THIS APPLICATION AND WILL BE RETURNED IF REJECTED

 

SPONSOR _______________________________________

 

NAME_________________________________PHONE NO.______________________

 

ADDRESS_______________________________________AGE___________________

 

TOWN, ZIP______________________________________D.O.B._________________

1        HAVE YOU EVER BEEN A MENTAL PATIENT?______________________

2        ARE YOU A CITIZEN OF THE UNITED STATES OF AMERICA_________

3        HAVE YOU EVER BEEN CONVICTED OF A MISDEMEANOR OR FELONY                                               OTHER THAN A MOTOR VEHICLE LAW VIOLATION?_______________

4         HAVE YOU EVER OR DO YOU NOW BELONG TO ANY ORGANIZATION CONSIDERED SUBVERSIVE BY THE ATTORNEY GENERAL OF THE UNITED STATES __________________

PARENTAL   PERMISSION,  LEGAL GUARDIAN

  1. ____________________________________                          DATE _________________

 

  1. ____________________________________                         DATE__________________

SCHOOL SPONSER

 

1._____________________________________                          DATE__________________

 

2_____________________________________                            DATE__________________

DRIVER’S LICENSE NUMBER________________________ IF APPLICABLE DATE_____________________

APPLICANTS SIGNATURE___________________________DATE___________

______________________________________________________________________________

BOARD OF DIRECTORS:        APPROVED___________DISAPPROVED_______________

                                                      

DATE_____________SIGNED________________________

              

FIRE COMPANY:                 APPROVED___________DISAPPROVED______________

                                                      

DATE_______________SIGNED_____________________

 

FIRE COMMISSIONERS:         APPROVED__________DISAPPROVED______________

                                             

DATE_______________SIGNED____________________