October 2005 - State Firemen's & Fire Marshals'

INDIVIDUALSFFMA Membership ApplicationJanuary to December 2006FIRE DEPARTMENTNameHome AddressCity, State, ZipCountyDOBHome PhoneE-mailSocial Security NoFire DepartmentOccupation/Work Phone NoMale [ ] Female [ ]DepartmentAddressCity, State, ZipCountyTelephone NoFax NoE-mail AddressPopulation ServedFire ChiefFire MarshalIndividual Membership$ 20.00ASSOCIATION / ORGANIZATIONOrganizationCertification CoordDepartment MembershipCheck No$AddressCity, State, ZipCountyTelephone No.Fax No.E-mailContactOrganization MembershipCheck No.$100.00SFFMADepartment Dues By Population$ 75.00 0 - 1,750$115.00 1,751 - 5,000$135.00 5,001 - 10,000$155.00 10,001 - 20,000$175.00 20,001 - 30,000$200.00 30,001 - 40,000$225.00 40,001 - +Mail membership application and comments to:State Firemen’s and Fire Marshals’ Association, 4450 Frontier Trail, Austin, TX 78745Phone: 512/454-3473 Fax: 512/453-1876 Email Address: rwicker@sffma.org“Contributions or gifts to State Firemen’s and Fire Marshals’ Association of Texas are not tax deductible as charitable contributionsfor Federal income tax purposes. However, they may be tax deductible under other provisions of the Internal Revenue Code.”16TEXAS FIREMEN OCTOBER 2005