APPLICATION FOR MEMBERSHIP HUDSON MOHAWK VOLUNTEER FIREFIGHTER'S ASSOCIATION, INC.
 
Counties of Albany, Rensselaer, Schenectady, Saratoga Fulton, Montgomery, Warren, Washington,  Columbia and Greene _____________________________________________________
 
To the Financial Secretary:      PLEASE print legibly
 
Type of membership: Individual __   Fire dept/company __    Association __
 
Name of Fire Dept/Company/Association: _______________________  
 
Last Name: ____________________ First Name: ___________________ MI: ____
 
Address: ____________________________________________________________
 
City: _________________________State:___Zip:_____  County: _______________
 
Email Address: ___________________________    Hereby makes an application in the Hudson Mohawk Volunteer Firefighter's Association, Inc Organization Dues are $10.00, Associations $15.00 and Individual dues are $8.00.
 
Date: __________    Proposed by: __________________________
 
        __________________________
 
(Signature of a Presiding Officer or Secretary of Organization  or signature of an Individual Member and HMVFA Member)
 
Make checks payable to Hudson Mohawk Volunteer Firefighter's Association, Inc.
 
ELIGIBILITY FOR MEMBERSHIP
 
Any Volunteer Fire Company, Volunteer Fire Department, Association of Volunteer or exempt Volunteer firemen and any active or exempt volunteer fireman who is serving or who may have served in any such company or department in the territory in which the operations of the Hudson Mohawk Volunteer Firefighter's Association, Inc. are authorized to be conducted.
 
Each member organization annually chooses two delegates to represent it at the convention of the Association.  Delegates so chosen may continue as individual members by payment of annual dues of $8.00.
 
Send this application with remittance to the Financial Secretary of the Association.  HMVFA  Financial Secretary                 c/o Phyllis Dinkelacker                                17 N. Vernon St                 Athens, NY     12015