Beacon Hose Membership Application
Beacon Hose Company No. 1 is an equal-opportunity employer. All applicants are considered for positions regardless of race, color, religion, sexual orientation, national origin, gender, age, ethnicity, marital status, military service, ancestry, or disability. Beacon Hose will make reasonable accommodations to known physical or mental limitations of a qualified applicant or member with a disability, unless the accommodation will impose an undue hardship on the operation of our business.
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Name (First and Last)
Current Street Address (Address, Town, State, ZIP)
Cell Phone Number
Alternate Phone Number(s)
Date of Birth
Which type of membership are you seeking? (Check all that apply.)
Junior Corps Fire (14-17 years old)
Junior Corps EMS (14-17 year old)
If you were previously a member of Beacon Hose, when was your membership active? (If not, skip this question.)
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