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Morris County Fire Prevention Association
2017 Membership Application
Please print or type.

Complete all appropriate fields including necessary documents for payment.

Regular Member $50.00 (per individual)

____ Fire Official/Marshal

____ Fire Inspector

____ Fire Protection Sub-Code Official

____ Fire Protection Inspector
 

Associate Member $100.00 (per individual)

____ Private Corporation

____ Fire Department

____ Other - Interested in Fire Protection

 

If you are more than one of the above please check all that apply:


Name ____________________________________________________________

LEA Name or Municipality/Corp./FD ____________________________________________

Street or P.O. Box ______________________________________________

City _________________________ State ___________ Zip Code __________

Phone # __________________ Cell # __________________ Fax # ____________________

E-mail address ____________________________________

Be sure to include your e-mail address as all minutes and notices are now sent by e-mail only.

 

Signature ___________________________________________ Date ___________________

 

Purchase Order #___________________ Check _____ Cash ________ Voucher submitted ____

 

Note: Dues cover the calendar year 1/1/17-12/31/17

**** Payment must accompany all returned applications ****
Return to the below address or bring to the next meeting.

Captain Ed Nunn
Madison Fire Department
62 Kings Road
Madison, NJ 07940

(To print this application, "right-click then print".)