Membership Interest Form
Lake Shore Volunteer Fire Company, Inc.
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
I’m interested in becoming a
Please Select
Firefighter
EMT
Junior Firefighter (Ages 10-15)
Auxiliary Member/Admin (non-riding member)
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
E-Mail
example@example.com
Preferred Contact Method
Please Select
Phone
Text
E-Mail
Best Time to Contact You
Submit
Should be Empty: