Hampton Professional FF Association Local 2450

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

APPLICATION FOR AFFILIATION

Email *

Please check the appropriate box *

Initial affiliation - includes $25.00 registration fee and first month dues $39.00 (total $64.00)

Reinstatement - include $25.00 and back dues (contact Treasurer for amount owed)

Retirement affiliation

Transfer from another IAFF Local (may have a transfer fee)

Date *

Name *

Birthday *

Mailing Address to include City and Zip Code *

Telephone Number (Cell and/or Home)

Email Address (Do Not Use City Email Address) *

Do You agree to give Local 2450 your bank routing number and account number to have your dues withdrawn automatically monthly? *

Yes

How will you be paying your dues? *

Yearly $468.00

Monthly $39.00

Biweekly (each City paycheck) $18.00

IAFF number (if reinstating)

Station and Shift Assignment *

NOTE: You will be affiliated the first month after you submit your application. The IAFF will issue an electronic membership card.

An invoice will be sent to the email address that is provided above. Please pay the invoice thru Quickbooks. Membership will not be in effect until payment is received. Any questions or comments please contact Secretary / Treasurer Jami Salvio 757-508-1736. You may also write any questions you may have below.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms