Application For Membership

I hereby make application for membership in the Burlington County Fire Marshal's Association Inc. in accordance with the constitution and By-Laws and agree to be bound therein. I am Transmitting $15.00 with this application, this is for annual dues. If for some reason I am denied, I understand that the aforementioned fee shall be given back. All information given by me is warranted to be true and correct.

Full Name:_______________________________________________ Date:_________________________

Home Address:_________________________________________________________________________

City______________________________ State:___________________ Zip:________________________

Home Phone:______________________________ Work Phone:__________________________________

Fax:______________________________ E-mail:______________________________________________

Employer:_____________________________________________________________________________

Address:_______________________________________________________________________________

City________________________ State:___________________ Zip:_________________________

Qualifications for
Membership:___________________________________________________________________________

References: (Complete name, Address, Phone #, Occupation and Title)

1.____________________________________________________________________________________

2.____________________________________________________________________________________

3.____________________________________________________________________________________

BCFMA Member Recommendation: (Name of member in good standing)

Name:________________________________ Address:_________________________________________

City:_____________________ State:__________ Zip:____________ Phone #:______________________

Signature of Applicant:___________________________________________________________________

BCFMA USE ONLY:
The trustees have investigated the applicant and the recommendation is to approve ____ Disapprove____, and the forward to the president for final vote at a regular meeting.
Signature of trustees:
1._________________________________________
2._________________________________________
3._________________________________________

Secretary signature:_____________________________________________________