Middlebury Fire Department Membership Application
Name: *
Address (street, town, state, zip): *
Email address:
Daytime phone number: *
Evening phone number (if different from daytime):
Date of birth (MM/DD/YYYY) *
Gender
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Marital status
How long have you lived in the town of Middlebury?
Next of kin name and relationship: *
Next of kin address and phone number(s): *
Are any of your relatives current or former members of the Middlebury Fire Department?
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If yes, who?
Why are you interested in joining the Middlebury Fire Department? *
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