ASVAC UNIFORM ISSUE FORM

UNIFORM ISSUE & AGREEMENT

Items Issued

Rows	QUANTITY	SIZE	COMMENTS
T-SHIRT
POLO SHIRT
QUARTER ZIP JACKET
FULL ZIP JACKET

If Pager issued, please fill the following details below:

Rows	MAKE	MODEL	SERIAL NUMBER
PAGER/PLECTRON

Issuing Officer:

Date of Issue:

MonthDayYear

THE UNDERSIGNED VOLUNTEER HAS RECEIVED THE REQUIRED UNIFORM / PAGER. THE VOLUNTEER AGREES TO MAINTAIN THE UNIFORM/PAGER IN CLEAN AND WELL-KEPT CONDITION.UPON RESIGNING OR BEING SEPERATED FROM THE CORPS, THE VOLUNTEER AGREES TO RETURN THE UNIFORMS/PAGER TO THE ARDSLEY-SECOR VOLUNTEER AMBULANCE CORPS. FAILURE TO RETURN THESE ITEMS WILL FORCE THE CORPS TO TAKE LEGAL ACTION.

Signature

Volunteer Name

First NameLast Name

Date

MonthDayYear