19307 Longmeadow Road

Hagerstown, MD 21742

301-797-5504

Name: ____________________________________________________________________________________

Address: __________________________________________________________________________________

City: _____________________________________________________________________________________

State: ____________________________________________________________________________________

Zip: ________________________________________

Phone: ________________________________________ (Home)

Phone: ________________________________________ (Work)

Date of Birth: _________________________________ (year optional)

Social Security Number: __________________________

Why do you want to join the Auxiliary? (Please feel free to attach another sheet of paper if necessary)

Please list TWO references, neither of which are family.

First Reference:

Name: _____________________________________________________________________________________

Address: _____________________________________________________________________________________

City: _____________________________________________________________________________________

State: _____________________________________________________________________________________

Zip: ________________________________________ Relationship:________________________

Phone: ________________________________________ Years Known:_______________________

Second Reference:

Name: _____________________________________________________________________________________

Address: _____________________________________________________________________________________

City: _____________________________________________________________________________________

State: _____________________________________________________________________________________

Zip: ________________________________________ Relationship:________________________

Phone: ________________________________________ Years Known:_______________________

If you become a member of this Auxiliary, will you adhere to the house rules and regulations of this company?

YES NO

______________________________________________ 

Signature of Applicant / Date

______________________________________________

Signature of Parent if Applicant under 18 / Date

Please mail this complete printed application to:

Longmeadow Volunteer Fire Company, Inc.

C/o Auxiliary President

19307 Longmeadow Road

Hagerstown, MD 21742

If you have any questions please contact the Auxiliary via e-mail through our website:

http://www.longmeadowfire.com