Date ______________

Application of ______________________________

For: (Regular-Active) (Regular-Inactive) (Associate) (Junior 16-18yrs)

D.O.B. __________ Social Security #______-_____-_____

Address_________________________________________________________________
(Street)
________________________________________________________________________
(City) (State) (Zip)

Phone # ____________________

Firefighting Experience____________________________________________________

_______________________________________________________________________

Application fee of $2.00 plus membership fee of $5.00 MUST accompany this membership application form.
Make checks payable to: Matunuck Volunteer Fire Department.

Applicant's Signature______________________________________________________

2 Sponsoring Members_____________________________________________________
(In good standings)
_____________________________________________________

All applicants must have a background check done and have it forwarded to the Matunuck Volunteer Fire Department at the above address before the association can approve full membership.
-----------------------------------------------------------------------------------------------------------
(For Fire Department use only)

Read Date____________

Voted Date___________ Approved____ Rejected____ Terminated____

Membership committee Chairperson Signature:_________________________________

Date:_____________