NEW CUMBERLAND FIRE DEPARTMENT

319 4^th street, new Cumberland, pa 17070

AUXILIARY

MEMBERSHIP APPLICATION

MEMBERSHIP FEE IS $5.00 DUE AT TIME OF SUBMISSION

 

 

            Name

 

            Address

 

            City                  State          Zip

 

    Phone #                 Cell #   

        

             Date of Birth

 

 

            Any other organizations you belong to :

 

 

            Signature

 

President Kathy Yoeman – Vice President Cynthia Kauffman

 

 

*DO NOT WRITE BELOW THIS LINE – AUXILLIARY USE ONLY*

__________________________________________________________________

 

Membership application received date: __________________

Membership application brought to the body:________________

Membership approved : _____________Member Contacted : _________

Dues Paid : _____________

 

Auxilliary Member Signature : _________________________________