LAUREL AUXILIARY TO THE LAUREL VOLUNTEER FIRE DEPARTMENT

APPLICATION FOR MEMBERSHIP

ARTICLE II

SECTION 1. Any person eighteen years of age or older is eligible for membership.

SECTION 2. Person must not be an active member of any other volunteer fire department auxiliary.

NAME: BIRTH DATE:

PLEASE PRINT MONTH / DAY

ADDRESS:

STREET ADDRESS CITY STATE ZIP

PHONE: ( ) ( )

Area Code HOME Area Code WORK or CELL

HOW LONG HAVE YOU LIVED IN THE AREA?

PLACE OF EMPLOYMENT:

REASON FOR JOINING THE AUXILIARY:

THREE CHARACTER REFERENCES

NOTE: (please do not include your employer as a reference and provide evening phone numbers):

1. NAME: PHONE NUMBER: ( )

PLEASE PRINT Area Code

2. NAME: PHONE NUMBER: ( )

PLEASE PRINT Area Code

3. NAME: PHONE NUMBER: ( )

PLEASE PRINT Area Code

SIGNATURE: DATE:

Mail Completed Application To: LVFD Auxiliary, P.O. Box 292, Laurel MD 20707

OFFICIAL MEMBERSHIP COMMITTEE USE ONLY (please do not write below this line):

1) 2) 3)

SIGNATURE OF COMMITTEE MEMBERS

1^ST READING: ACCEPTED:

2^ND READING: NOT ACCEPTED: