Fire Roster Change Form

Submitted by: Your Name (required)

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Submitted by: Your Title (required)

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Agency (required)

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Your Email (required)

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Add Member #1

Member names MUST be added as their LEGAL name as it appears on their Driver's License. Nicknames, abbreviation, or middle names cannot be used on the roster.

When adding a member, all information below is REQUIRED.

Member Full LEGAL Name

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Rank (ie: FF, EMT, Capt, Probationary, Asst. Chief, Secretary, Treasurer, etc.)

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Mailing address (Street, City, State)

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Zip Code

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Date of Birth

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Cell Phone Number

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Email Address

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Receive Text Paging?

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Is the new member 17 years or younger?

Yes

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Add Member #2

Member names MUST be added as their LEGAL name as it appears on their Driver's License. Nicknames, abbreviation, or middle names cannot be used on the roster.

When adding a member, all information below is REQUIRED.

Member Full LEGAL Name

Invalid value

Rank (ie: FF, EMT, Capt, Probationary, Asst. Chief, Secretary, Treasurer, etc.)

Invalid value

Mailing Address (Street, City, State)

Invalid value

Zip Code

Invalid value

Date of Birth

Invalid value

Cell Phone Number

Invalid value

Email Address

Invalid value

Receive Text Paging?

Invalid value

Is the new member 17 years or younger?

Yes

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REMOVE Roster Personnel:

Member name to remove:

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Personnel phone number to remove:

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Removal effective date:

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REMOVE Roster Personnel:

Member name to remove:

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Personnel phone number to remove:

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Removal effective date:

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