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Morris County Fire Prevention Association

P.O. Box 96

Ledgewood, NJ  07852

 2010 Membership Application

Please print or type.  Complete all appropriate fields including necessary documents for payment.  Be sure to include your e-mail address as all minutes and notices are now sent by e-mail only.  Return to the above address or turn in at a meeting.

____    Regular Member $30.00 (per individual)

If you are more than one of the below please check all that apply:

____    Fire Official

____    Fire Inspector

____    Fire Protection Sub-Code Official

____    Fire Protection Inspector

____    Associate Member $75 (per individual)

____    Private Corporation

____    Fire Department

____    Other -- Interested in Fire Protection

Name  ___________________________________________

LEA Name or Municipality/Corp./FD ____________________________________

Street or P.O. Box _______________________________________ 

City ______________________ State ________  Zip Code __________

 Phone # __________________ Cell # __________________ Fax # ____________________

 E-mail address _________________________

Signature ___________________________________________ Date ___________________

Purchase Order #___________________ Check _____ Cash ____  Voucher submitted ___

Note: Dues cover the calendar year 1/1/10-12/31/10

**** Payment must accompany all applications ****

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