Massachusetts Institute of Fire Department Instructors
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Membership Application
Jan. 1 to Dec. 31, 2008
Membership
Information
Name
________________________________________________
Address
________________________________________________
City & State
________________________________________________
Zip Code
________________________________________________
Phone (Home)
________________________________________________
E-mail Address
________________________________________________
Fax (Home)
________________________________________________
Work
Information
Department
________________________________________________
Rank ________________________________________________
Phone (work)
________________________________________________
Fax (work)
________________________________________________
Address (work)
________________________________________________
City & State (work)
_______________________________________________
Zip Code
_______________________________________________
Membership
Type
Send Bulletin
To:
Membership Dues
circle
one
circle
one
Active
$25.00
Retired $12.50
Active
Retired
Associate
Home
Work E-mail
Associate $100.00
Mail completed
Application with check or money order. to:
Michael McLeieer, MIFDI Treasurer
PO Box 507, Merrimac, MA
01860-0510
Phone:
(978) 864-2015 or (978) 346-4731 ext. 1
E-mail: michael.mcLeieer@merrimacfire.com