NOTICE: DUE TO TECHNICAL ISSUES WITH OUR PROVIDER, WE WILL HAVE TO SUSPEND CREDIT CARD PAYMENTS FOR TAX PAYMENTS UNTIL FURTHER NOTICE. THANK YOU. The last day the pool will be open is SUNDAY, AUGUST 23. Thanks for a great season!Description

Fire Department Application

Name

This field is for validation purposes and should be left unchanged.

Application for Department Membership

Name

First Last

Date

Address

DOB

City, State & Zip

Phone

Hose Company Joining

Email

Are you over the age of 18?

Yes

No

I hereby agree to take an active part in all fire fighting activities, attend the first fire school class and special demonstrations pertaining to fire fighting when available and to obey the orders of my superior officers at all times. I also agree to abide by the Constitution and By-laws of the DuBois Volunteer Fire Department, DuBois, PA and the DuBois Volunteer Firemen's Relief Association, DuBois, PA.

Parent or Guardian Signature (if under age 18)

Applicant Signature

Application for Relief "Death Benefits" Membership

I desire to become an eligible member for the "Death Benefit" of the DuBois Volunteer Fireman's Relief Association. My membership being based upon being a member of the above named company. I hereby designate as my beneficiary to whom such death benefit shall be payable:

Name

First Last

Relationship

Address

City, State & Zip

Parent or Guardian Signature (if under age 18)

Applicant Signature

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