WHITE VALLEY VOLUNTEER FIRE DEPARTMENT

APPLICATION FOR MEMBERSHIP

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Relying upon the assurance that the White Valley Volunteer Fire Department is an organization consecrated to the ideals and traditions of America; that it pledges its membership in obedience to the duly constituted Federal, State, and Municipal authorities of the United States; that it obligates its membership to the practice of the principles of benevolence and high social ideals. I do hereby respectfully request admission into your organization as a member, and promise and agree if accepted, to obey the rules and regulations of your organization and those of the State of Pennsylvania.

Applicant's Signature:  ______________________________________

I hereby present the application of the above named applicant whom is a reputable person and worthy in every way to become a member of this organization.

Proposers:  ______________________________________________

                  ______________________________________________

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APPLICANT

Name:  _________________________________________________

Address:  _______________________________________________

Phone Number:  __________________________________________

Social Security Number:  ___________________________________

Date of Birth:  ____________________________________________

Beneficiary:  _____________________________________________

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CERTIFICATION

I hereby certify that the above applicant was duly accepted into our organization as a  ___________________  member on the  ___________  the day of  ___________  20 ___.


President:  __________________________  Secretary:  __________________________


To print this application, click the print button.        

Mail to: Chief John Bohinc, White Valley VFD - 6215 Old William Penn Highway, Export, PA 15632

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