MVR Membership Application Form
Please fill out the following form to submit an application of membership to Missisquoi Valley Rescue. Your personal information will be kept private and not be disclosed to any outside parties. Election to membership shall be on a 90-day probation basis. To become a member in good standing, each approved applicant
will have to follow MVR Bylaws and Section 2.1 and 2.2 of the Membership Manual. The Board of Directors may withdraw approval of any application if the applicant fails to complete the above conditions. Membership is not transferable.
Last Name *
First Name *
Age
Date of Birth
MM
/
DD
/
YYYY
Address
Email *
Phone number *
Driver's License # *
Social Security #
Occupation *
Employer *
3 References (Full Name and Phone Number) *
Have you ever been convicted of? *
YES
NO
A misdemeanor
DWI / DUI
A felony
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