Individual Application To Join The Iowa Firefighters Association
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1INDIVIDUAL APPLICATION TO JOIN THE IOWA FIREFIGHTERS ASSOCIATION
Being an active member in good standing of the
(Dept.Name), Iowa Fire
Department, I hereby apply for membership in the Iowa Firefighters Association and herewith
tender the sum of $
in the payment of dues for the current year. The dues are $13.00 per
th
year, per member. NOTE: The dues for new members who join after June 30
and through the
convention meeting of that current year are one-half the Annual dues ($6.50) for the balance of
th
the year. NEW MEMBERS who join after September 30
will be given credit for the following
year on payment of the Annual dues ($13.00).
Applicant’s signature:
___________________________________________________
Date of Application: Month
Day
Year
______
______
________
Amount Enclosed: $
__________
Please type or print:
First Name:
M.I.
______________________________________
_____
Last Name:
______________________________________
MAILING address
:________________________________
City or Town
Zip Code
:___________________________
_______________________
Phone Number
E-Mail Address
_________________________
____________________________
Are dues paid by you as an individual?
or by your Fire Department as a group?
_____
_____
(check one)
Have you ever been a member of the Association before? Yes
No
______
______
The above statement of Fire Department Membership is correct.
Signed:
,Chief Officer, Secretary or Treasurer
________________________________________
MAIL TO: Wendy Lensing, Executive Director, PO BOX 67, Humboldt, IA 50548
Phone: 515-332-1503.
Those who wish to join the Mutual Aid Department for $500 death benefit must fill out a Mutual
Aid application form. To join Mutual Aid you must be 40 years of age or younger at time of
application. For additional Mutual Aid or Association forms, contact the Executive Director’s
Office.
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