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New York State Association of Fire & Lifesafety Educators

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Application

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 

  • 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___________________

     


    please print, fill out and mail this page

     

    NYSAFE, 102 Merideth Ave, Nedrow, NY 13120
     
    Copyright 2010 NEW YORK STATE ASSOCIATION OF FIRE SAFETY

     EDUCATORS. All Rights Reserved.