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Retiree Membership Application
Sarasota Firefighters Benevolent Fund
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* Indicates required question
I verify that I am a retired Sarasota County Fire Department Employee
*
YES
No
Required
Purpose for application:
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New Membership - Retiree
Address Change
Name Change
Withdraw of Membership
Name
*
Your answer
Date of retirement
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MM
/
DD
/
YYYY
Spouse's Name (if applicable)
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
I do hereby apply for retiree membership of the Sarasota Firefighters Benevolent Fund and agree to abide by the by-laws of the organization. I will conduct myself in a manner befitting this membership.
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Choose
YES
NO
I understand that retiree membership requires an annual fee of $65.00 for membership dues to the Sarasota Firefighters Benevolent Fund. I agree to submit this payment by January 15 each year.
*
No, I am filling this application out for a reason other than membership
Yes, I understand.
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