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Name___________________________________ Soc Sec#_________________________________ Address_________________________________ Phone Number_____________________________ DOB_______________________________ E-mail__________________________________________ Place of Employment____________________________ Work Phone________________________ Emergency Contact________________________ Phone_______________ Relationship________ Why do you want to join?_____________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Hours Available_____________________________________________________________________ I understand that in order to maintain my status as a voting member, I must attend at least 8 monthly meetings and one fund raising event during the departments fiscal year. I also understand that I will be a probationary member for the first 6 months. Any certification training that the department funds during the probationary period will be reimbursed by me if I fail to remain an active member of the department for one year. I agree to abide by these rules and any other rules, by-laws, procedures and policies the Bungay Fire Brigade. Signature_______________________________________________ Date_____________________ Department use only Application date_______       Member ID__________Probation begins____________  Probation ends _____________