GSFA Membership Form

GEORGIA STATE FIREFIGHTERS ASSOCIATION

521 1st Street, PO Box 10, Milford, Nebraska 68405
Telephone: (770) 914-7774 • Fax: (770)914-7773
Email: info@gsffa.org Website: www.gsffa.org
GSFA Membership Application
Dues:
Active / Active Retired / (Receive a 10% discount for paying for three years)
Retired Members - $6
Would you like to add $18 to your GSFA Dues to join the National Volunteer Fire Council (NVFC)?

This discounted membership rate is available to GSFA members. See the GSFA website (www.gsffa.org) – Member Benefits section for details.

If Yes, Please add the selection below.
Memberships:
prevnext( X )
Membership Dues$25.00

Active Retired$25.00

3-year Active Member (10% Discount)$67.50

Retired Members$6.00

Join the National Volunteer Fire Council - (NVFC)$18.00

Total $0.00
Please select type of membership*

New MemberRenewalActive MemberActive Retired MemberRetired Member
Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
E-Mail*
enter NONE if does not apply
Organization/ Fire Department Name*
Beneficiary Name*
enter NONE if does not apply
Date of Birth*

MonthDayYear
If renewal, have you had a change of address or changed departments since last renewal? If so, list change
Were you recruited through personal contact? If so, give name of person(s) that you talked with
Membership information received from*
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GSFA Membership Application