Utah State Firefighters' Association
Organized September 16, 1908 Incorporated August 18, 1910
USFA Convention Grant Application
Contact: Dave Chugg P.O. Box 693 Grantsville, Utah 84029 david.chugg@slcgov.com
Name
*
First Name
Last Name
Applicant Fire Department
Lifetime member? If yes, what year did you become one?
Yes / No
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
When was the last convention you attended?
Example: Never, 2010, etc.
Are you receiving a service award?
Yes / No
Does your department receive funding from the municipality you serve to send members to convention:
Yes / No
Please tell us in short, why you should be selected to receive a $250.00 grant to attend convention to the following address prior to the first Friday in January of the year you are applying for:
Submit
Should be Empty: