Application For Department Membership Date Date Format: MM slash DD slash YYYY VSFA District #Refer to VSFA District MapTo the Officers and Executive Committee Gentlemen: Having become acquainted with the objects and principles of your Association, I respectfully submit the active roll of the below Comany or Department for membership in the Virginia State Firefighter’s Association.Name of Company or Department*Location of Organization (City, County, Town)Permanent Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Population of area assigned and responds on first calls and or runsFee per Member Price: $5.00 Number of Members*Please enter a number greater than or equal to 10.Total $0.00 Fax NumberMain Station Phone No.*Chief or President Chief Predident Chief or President NameEmail* Enter Email Confirm Email Cell PhoneSecretary Name* First Last Secretary Email Cell PhoneTreasurer Name* First Last Treasurer Email Cell PhoneRoster RequestIn an effort to establish a better line of communication between the VSFA and our member departments, as well as ensure our records are accurate and up to date; we would ask that an updated ACTIVE Membership Roster (complete with names and email addresses) be submitted along with your membership renewal dues & application. Please send your membership rosters either by email to the VSFA Secretary at firstname.lastname@example.org or by mail to our new mailing address listed in red on the following page.Payment Information Add new card Article 1,Section 2, Constitution -Any fire department, company, or rescue squad of the State of Virginia in active service, and officers of the same, which presents its roll of membership from the foreman, the President, or Chief of the company, after having received the majority vote of the Executive Committee, shall be entitled to membership in the association upon payment of such dues as may be prescribed.Article 1, Section 1, By-Laws -Application for membership in this Association shall be accompanied by a fee of Fivedollars($5.00) for each member on the books of the company or department making the application. Same to be forwarded to State Association Secretary, signed by the Secretary of the Company of Department or its President or Chief. Companies or departments making application must consist of at least ten (10) membersCommentsThis field is for validation purposes and should be left unchanged.