NEW MEMBER DISCLOSURE & INFORMATION FORM

 

 

I, ___________________________(print your full name), wish to become a member of the 118th NY Co. F. I understand that by signing this form I am bound by all rules, regulations and safety procedures outlined in the  By-laws and Safety Manuals. I furthermore agree to pay all membership fees, dues and insurance premium payments upon acceptance into the company. I furthermore understand that by joining the company I will be placed on probationary status for the term of (1) calendar year and may be dismissed from above said company for By-law or Safety Manual violations @ anytime during this probationary period, pursuant to By-law procedures. I furthermore agree and understand that I am obligated to secure a proper period impression and obtain proper equipment to sustain that period impression within the (1) calendar year period, from the date of acceptance (stated below). I understand that all impressions must be approved by the company in order to be secured as a unit impression. I furthermore agree to be an upstanding member of the Company and portray an accurate period impression to the best of my ability.

 

Signature of Applicant:(must be 18yr+ to sign);_Signature of Parent or Guardian *________________________                         *  _______________________________

Date:_______________               Date:____________________

________________________________________________________________________

Type of Impression Applicant wishes to portray: (Circle One)    Civilian         Military

Signature of @ least 1 Board Member is required for validation:

Commander(s):___________________________, Date:_________________

Civilian Liaison:___________________________, Date:_________________

1st Sgt:___________________________________, Date__________________________

Date of Member Acceptance:__________________

Board Member Comments: (See Back)

Date Dues were paid:______________       Amounts  Paid:________________

________________________________________________________________________

MEMBER INFORMATION

Address of Applicant:(Please Print)

Street:_____________________________________ City/Town:____________________

State:__________   Zip:__________ E-mail Address:_____________________________

Home Ph#:_________________________  Cell Ph#:_____________________________

Dependant Minors Under Your Membership: (Names in Full, Use back if Needed)

http://118thny.org/