New York State Association of Fire & Lifesafety Educators Membership Application
___ New
___ Renewal
Name:
_______________________________
Address:
_________________________________
City: ___________________
State:
___________
Zip Code: ____________
e-mail:
_________________________________________
Affiliation: ( Please check all that apply)
___ Firefighter ___ Educator ___ EMS ___ Fire Administrator ___ Sponsor
Affiliation
fire company name: _________________________________________________
Membership level: ___ Individual
Active
$10.00
___ Sustaining / Organizational
$50.00
Sponsor level:
___ Friend / Patron $250.00
___
Silver
$500.00
___ Gold
$750.00
___ Platinum
$1000.00
- ACTIVE MEMBER:
Persons eligible to become active members are individuals who
have an interest in fire and life safety education and are willing to fulfill the objectives and purposes of the association.
- SUSTAINING
MEMBER: Those eligible to become sustaining members are
individuals, firms, corporations, institutions, societies, associations, board, bureaus, or commissions wishing to assist
in attaining the objectives of the association.
- ORGANIZATIONAL MEMBERS:
Emergency service organizations are eligible to become organizational
members. Each organizational membership is entitled to have 5 active members listed on the association mailing list.
Mail will be sent to all 5 members.
For
organizational memberships, please fill out an application for each member to be listed under the organizational membership.
Please enclose a check for the appropriate amount and send to the address below.
Signature_______________________________
Date___________________
