Team Registration
The 2017 Dan Jock Memorial Fireman's Muster will be held on August 13, 2017 at the VFW Memorial Field in North Haverhill, NH.

Further details regarding the day of the event (i.e. registration time, what equipment to bring, etc.) will be e-mailed to registered teams by August 6, 2017.

Teams will be comprised of 5 members. The team members MUST be the same for all events.

The registration fee is $100.00 per team and you will not be considered registered until your fee is received (see additional instructions at the bottom of this form).

Department Name *
Your answer
Team Leader Contact Phone Number *
Your answer
Team Leader Contact Name *
Your answer
Team Leader Contact E-mail Address *
Your answer
Team Members
Please list 5 team members. If this list changes at any point prior to your arrival on August 13, please be sure to contact us as soon as possible with the new team member's name and who he/she is replacing.
Team Member 1: Name & Rank *
Your answer
Team Member 2: Name & Rank *
Your answer
Team Member 3: Name & Rank *
Your answer
Team Member 4: Name & Rank *
Your answer
Team Member 5: Name & Rank *
Your answer
Additional Information
Checks should be mailed to:
DJ Memorial Fireman's Muster
c/o Kaylee Heathe
585 Monroe Rd
Bath, NH 03740

Please make checks payable to WFD Fire King Hose Company.

WFD Fire King Hose Company is a 501(c)(3) Non-Profit Organization

WFD King Fire Hose Company and the DJ Memorial Fireman's Muster Committee and/or all sponsoring entities are in no way responsible for any theft, damages, or injuries at this event.

Please contact Kaylee Heathe at djmemorialmuster@gmail.com with any questions.

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