Interest Form for Prospective Membership - West Friendship Volunteer Fire Department

Indicates Required Field

Membership Type Required

Area of Interest Required

First Name Required

Middle Name

Optional

Last Name

Preferred Name

Optional

Date of Birth Required

Gender

Street Address Required

City, State, Zip Code Required

Cell Phone Number Required

Email Address Required

Occupation (if a student, please list current school) Required

Have you ever been convicted of any violation of the law, other than minor traffic violations? Required

If you have ever been convicted of any violation of the law, other than minor traffic violations, please explain:

Only if you answered Yes

Have you ever applied to or been a member of another department? Required

If yes - please indicate the name of the department or departments:

Only if you answered Yes

What is your current membership status and, if applicable, why did you separate from the department?

Only if you answered Yes

If the applicant is under 18, a parent or guardian must complete the following:

Parent/Guardian Name

Only if applicant is under 18

Parent/Guardian Phone

Only if applicant is under 18

Parent/Guardian Email

Only if applicant is under 18

By submitting this interest form, I acknowledge that all statements are true, complete, and correct, to the best of my knowledge.

Electronic Signature of Applicant Required

Signature of Parent or Guardian (If Applicant Is Under 18)

Only if applicant is under 18