USFA Membership Application
Once you submit your application, please contact the Membership Steward to get an invoice for your dues sent to you. (Membership Steward's contact info is located on at www.fireassociation.com under the Officers tab. Cost is $15.00 per year and a 1-time application fee of $10.00.
I hereby make application to become a member of the Utah State Firefighters' Association; I am sound in bodily health to the best of my knowledge and belief, 18 years of age or over, and if accepted, I promise a free and due observance of all laws and regulations that govern the organization.
City, State
Date
Name
First Name
Last Name
Date of Birth, Location: City or Town, County, State
Date and Location
I am an active member of the:
Dept. Name and Hire Date
My Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list two beneficiaries including your relationship to them. Also include their mailing address, email address, and a contact number for them.
Name of your Department Chief and their email address:
Signature
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