IAFF Membership Registration Form

Member/ Mentor Application

Uplifting Fathers. Reshaping Families. Changing Communities.
Name *

First Name Last Name
E-mail *
Phone Number: *

Area Code Phone Number
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
MARITAL STATUS *
Birth Date:

Month Day Year
EMPLOYER
JOB TITLE
HOW MANY CHILDREN ?
CHILDRENS NAME ?
WHAT SKILLSET DO YOU BRING TO THE ORGANIZATION?
HAVE YOU EVER BEEN CONVICTED OF A FELONY?
HOW DID YOU HEAR ABOUT US?
PLEASE LIST YOUR SOCIAL MEDIA HANDLES
Membership Rules
MEMBERSHIP RULE

1. Membership is available to anyone 18 years of age or older.

2. Must participate in minimum of (4 ) events per calendar year.

3. Must communicate with assigned mentee at least (1) time per month.

4. Must pay annual membership fee of $250.00 at the start of the agreement and upon approval.

5. While acting on behalf of IAFF, professional behavior and respectful discourse shall be required of MENTORS. Disruptive or inappropriate behavior toward mentees, volunteers, stakeholders or staff is unacceptable.

6. Mentors shall not persuade or attempt to persuade any mentee, member, sponsor, supplier, contractor, or any other person or entity with an actual or potential relationship with the Association to terminate, curtail or not enter into its relationship to or with the Association, or in any way to reduce the monetary or other benefits to the Association of such relationship.
PLEASE UPLOAD YOUR DRIVERS LICENSE OR STATE ID CARD

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I have read, understood, and accepted the rules for membership.
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!

Membership Fee *

USD Description

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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Member/ Mentor Application

Membership Rules