Future Operations Base Membership Form

Future Operations Base Membership Form
Date *

Month Day Year
Date
Name of Applicant *

First Name Last Name
Date of Birth *

Month Day Year
Date
Email *
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Emergency Contact

For Volunteering Purposes
Emergency Contact’S Name

First Name Last Name
Emergency Contacts Phone Number

Area Code Phone Number
Relationship
Military Membership:

Complete Only if You Served in the Military
Status:

Active Duty Retired Veteran Reserves
In which Military Branch did you serve?
Dates Served
Rank
Type of Separation
Type of Disability and Rating
Are you able to provide a copy of your DD-214?

Yes No
First Responder Membership

Complete Only if You Served as a First Responder
Type of Service

Law Enforcement Fire Fighter EMS Dispatch Corrections
Organization
Title
Division
Status
Time Period Served
Widow/Widower Membership

Complete only if Widow/Widower of Service Member/First Responder
Name of Spouse
Type of Service

Military First Responder
Branch/Organization of Spouse
Time Served
Are you able to provide proof of service?

Yes No
Family Membership

Complete if Seeking a Family Membership
Choose One
Name of Family Member
Your Relation to Family Member
If "Other" What is your relation to the Family member?
Current Status of Qualifying Relative
Do you have the ability to prove this relation?

Yes No
How?
Your current occupation:
Name of Company:
F.O.B. Kids Membership

Children younger than 16
Name of Child 1

First Name Last Name
Date of Birth

Month Day Year
Date
Name of Child 2

First Name Last Name
Date of Birth

Month Day Year
Date
Name of Child 3

First Name Last Name
Date of Birth

Month Day Year
Date
Name of Child 4

First Name Last Name
Date of Birth

Month Day Year
Date
Volunteering Information

Complete if You Would like to Volunteer with F.O.B.
Are you interested in volunteering with Future Operations Base?

Yes No
What Skill-sets do you have and would like to share with F.O.B.

Woodworking Welding Fabrication Tile Work Plumbing HVAC Electrical Home Repair Automotive Repair Small Engine Repair Computer Skills Drafting Painting Manual Labor Landscaping/Yardwork Great Conversation Event Planning Member Engagement
Are you licensed or professionally trained in any of the skills above? If so which?
Would you like to serve on a committee?

Yes Interested
Do you own or work for a company that would like more information about being a F.O.B. Community Partner or Sponsor?

Yes
How did you hear about FOB?
If by word of mouth who told you about us?
All applicants for membership may be required to undergo a Criminal History Check. However, having a criminal history does not automatically preclude you from membership per F.O.B. Bylaws. By clicking submit the applicant agrees to undergo a Criminal History Check, and have to the best of their knowledge provided complete and correct information on the above application.
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Future Operations Base Membership Form

Emergency Contact

Military Membership:

First Responder Membership

Widow/Widower Membership

Family Membership

F.O.B. Kids Membership

Volunteering Information