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Membership Application Form Please print this page, fill it out, and mail it to the Department (HVFD #1, 2536 Duncan Avenue, Allison Park PA 15101) or bring it by the fire hall on a Wednesday evening during our regular drill or membership meeting events. Name (first, middle initial, last, spouse first name): _________________, _________________, _________________, _________________, Street Address: _______________________________________________ Home Phone: (___) ____ - ______ Other Phone: (___) ____ - ______ Marital Status (s/m): ____ Number of dependents: ____ I am applying to be: an Active Firefighter (_) a Junior Firefighter (_) a Business Member (_) I have been a member of a fire company prior to this application (y/n): ____ I am willing to comply with the bylaws of this Fire Department (y/n): ____ I would like to become a member of this department for the following reason(s): ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
For Fire Department Use: Date Received: ___/___/___ Date brought up for review: ___/___/___ Membership Committee: __________________ __________________ __________________
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