Mail –In Application For Membership

Big Run Area Volunteer Fire Company
105 E Main St     P O Box 315
Big Run PA 15715-0315
Phone (814) 427-2881
Fax (814) 427-5070

Mail -In Application


Name:___________________________

Address:_________________________
(Need not be a Big Run Borough Resident)

Date:___________   Age:___________
         (must be at least 16 years old to apply)

Phone #:___________________

Date of Birth:________________

SSN #_______________

Position Desired:  ____   ____   ____   ____   ____
(Please list in order of preference #1 being most desired)

1. Firefighter  2. Medical Responder  3. Fire Police
4. Radio Communications  5. Support Member

(All positions are considered Active Status)

Please include a short paragraph about your goals for yourself and the company if you where to be
accepted as a member of the Big Run Area Volunteer Fire Company.
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

I have never been convicted of an offense that
constitutes the crime of "arson and related offenses"   under 18 Pa. C. S.  3301 or any similar offense under any Federal or State law.
I hereby certify that the statements contained herein are true and correct to the best of my knowledge and belief.
I understand that if I knowingly make any false statement herein, I am subject to penalties prescribed by law, including, but not limited to, a fine of at least $1,000.00.

                                                                                             ------------------------------           ----------------                            Applicant's Signature                Date                                                                                                                                                                                                         

Please print this application, complete it and return it to the above postal address.  Once the application is received, the applicant will be contacted for an informal interview, after which the company will determine membership status.

STATION 17 HOMEPAGE | 15 YEARS AS CHIEF | ENDING OF AN ERA | FIRE SAFETY TIPS | MAIL -IN APPLICATION
FOR  MEMBERSHIP | UPCOMING EVENTS | THUNDER IN THE
BURROW     2008
| FACILITY  RENTAL  INFORMATION & FORM | EQUIPMENT PHOTOS | MAIL-IN DONATION FORM

PHONE: 814-427-2881
FAX: 814-427-5070
EMAIL: BRAVFC17@VERIZON.NET
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