Active Membership shall be available to any active, retired or disabled firefighter, or other public safety provider, owning or having access to a motorcycle and possessing a valid motorcycle license. Applicant Name Address Address 2 City Zip Code Home Phone Cell Phone Work Email Address Facebook Name Fire Department Name: Rank: Chief’s Name Phone Number Motor Vehicle License # Class Name of Sponsor Emergency Contact Phone Number Relationship Second Number I swear the information given is true and correct to the best of my ability: Applicant Signature Contact us at: or Call 518-365-8390 Official Use Only Application Submitted Application VOTED on Elected Rejected Tabled Reason tabled Application Fee $30.00 received by Date
Active Membership shall be available to any active, retired or disabled firefighter, or other public safety provider, owning or having access to a motorcycle and possessing a valid motorcycle license. Applicant Name Address Address 2 City Zip Code Home Phone Cell Phone Work Email Address Facebook Name Fire Department Name: Rank: Chief’s Name Phone Number Motor Vehicle License # Class Name of Sponsor Emergency Contact Phone Number Relationship Second Number I swear the information given is true and correct to the best of my ability: Applicant Signature Contact us at: or Call 518-365-8390 Official Use Only Application Submitted Application VOTED on Elected Rejected Tabled Reason tabled Application Fee $30.00 received by Date
chapter_liii_application.docx