© 2012 Firefighters Hall & Museum. All rights reserved.

MEMBERSHIP FORM

• NAME:

• ADDRESS:

• CITY:

• STATE:

• ZIP:

• Fire Service/Institution/Corp.Org.:

• Annual Membership

  Individual Member = $36   Family Member = $48   Friends of the Fire Museum = $100   Fire Service Organization = $200   Institution/Corporate = $300

• Life Membership

  Individual Member = $500   Family Member = $1000   Fire Service Organization = $1000   Institution/Corporate = $5000

• Charter Life Membership:

  Individual Member = $1000   Family Member = $2000   Fire Service Organization = $3500   Institution/Corporate = $10000

• Contribution (tax deductible) $

• Total Enclosed $

• Make Check Payable to:

  B&BDFH&M

• Date