2017 Nsvfa Member Only Department Enrollment Form

2017 NSVFA MEMBER ONLY DEPARTMENT ENROLLMENT FORM REMEMBER: MEMBER ONLY Departments may NOT add members after Dec. 31st! MEMBERSHIP TERM: JULY 1, 2017 to JUNE 30, 2018

Renewing Departments: Review & return enclosed roster adding emails. Ple ase see the enclosed blank enrollment form to list members’ names in alphabetical order. Add their complete mailing address, phone number and email.

New Membership Departments enrolling for the first time: Please see the enclosed blank enrollment form to list ANY members’ names - in alphabetical order – you would like to join. Complete their complete mailing address, phone number and email.

DEPARTMENT (NAME) MAKING MEMBER ONLY DEPARTMENT APPLICATION:

WE PLAN TO ENROLL AS A MEMBER ONLY DEPARTMENT – $110 FOR DEPARTMENT AND FIRE CHIEF! PLUS $20 FOR EACH MEMBER - ENROLLING ONLY THE MEMBERS LISTED BELOW. INCLUDED IN EACH MEMBER’S IS A ONE YEAR NEBRASKA FIREFIGHTER NEWSPAPER SUBSCRIPTION BEGINNING WITH THE OCTOBER, 2017, ISSUE.

MEMBER ONLY DEPARTMENT = $______MEMBERS @ $20.00 EACH = $______

 DUES PAYABLE BY CHECK OR CREDIT CARD (FORM ENCLOSED) TO THE: NSVFA, PO BOX 318, Arlington, NE 68002- 0318

DEPARTMENT CHIEF: DEPARTMENT SECRETARY: NAME: ______NAME: POSTAL ADDRESS: POSTAL ADDRESS: CITY: ST: ___ ZIP: CITY: ST: ___ ZIP: EMAIL: ______EMAIL: DAY PHONE: ______DAY PHONE: IMPORTANT DETAILS FOR NSVFA ENROLLMENT

Emails are extremely important for good communications:

Grace Period = NSVFA memberships are renewable beginning July 1. IF MEMBERSHIPS ARE NOT RENEWED by SEPTEMBER 1, the member benefits of the $4,000 accidental death/dismemberment insurance coverage and the newspaper will discontinue. Members not added or renewed by Dec. 31 will NOT be eligible for the significant Fire School Discount Department members receive benefits per member, not by department.

Remember: Member only departments may add additional Nebraska Firefighter subscriptions for non-NSVFA members for just $10.00 per subscription! Simply include their name on the ‘Subscription’ form. Thanks! Nebraska State Volunteer Firefighter’s Association P O Box 318, Arlington, Nebraska 68002-0318 “ADDITIONAL OR NEW NSVFA MEMBERSHIPS ______Fire Department PLEASE PRINT ADDITIONAL OR NEW MEMBER INFORMATION BELOW:

Name: Postal Address: City / Zip Code Telephone: Email Address

Name: Postal Address: City / Zip Code Telephone: Email Address Nebraska State Volunteer Firefighter’s Association P O Box 318, Arlington, Nebraska 68002-0318 Telephone: Toll Free (800) 642-6024 D/D (402) 478-4881 Fax: (402) 478-4762 Email: [email protected] Web: www.nsvfa.org