Utah State Firefighters' Association
Organized September 16, 1908 Incorporated August 17, 1910
Application for Membership
Contact: Dave Chugg PO Box 693 Grantsville, Utah 84029 Email: dave.chugg@slcgov.com
Name
First Name
Last Name
Department name which you are an active member of and your hire date
Example: Tooele Fire Dept 01/01/2010
Please include: Date of Birth & where you were born
Example: 01/10/1950 Salt Lake City, Utah
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list two Beneficiaries including your relationship to them along with a contact phone number
Example: Ben Salt, son 801-xxx-xxxx Cathy Salt, daughter 435-xxx-xxxx
Chief of your departments contact information
Chief Mike Smith, phone xxx-xxxx, email karl.lieb@xxx.com
Submit
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