INDIANA FIRE CHIEFS ASSOCIATION 2011 MEMBERSHIP APPLICATION Name: Title: Department Name: Department Address: City: State: ZIP Code: Phone: E-Mail: Fax: State Senate District: US Congressional District: IN Homeland Security District: State Representative District: MEMBERSHIP CATEGORIES ACTIVE MEMBERSHIP - Active Membership shall be comprised of the Chief of Department and any Chief Officer Rank of a regularly organized Fire Department officially recognized by the State Fire Marshal’s Office. Active members shall be entitled to vote on all matters requiring a vote unless otherwise prohibited by the Constitution and By-Laws and shall be entitled to hold elective office. For departments with less than 30 emergency responders, the Fire Chief and one (1) Assistant / Deputy Chief will be identified as active members who will have voting rights, all others of that department will be considered to have Departmental Membership. DEPARTMENTAL MEMBERSHIP – Departmental Membership shall be a department with less than 30 emergency responders. Departmental Members shall be entitled to participate fully in the affairs of the Association. The Fire Chief and one (1) Assistant / Deputy Chief of each department will have voting rights. All other members will be considered associate members. * attach roster list of member names. ASSOCIATE MEMBERSHIP – Associate Membership shall include individuals interested in the protection of life and property from fire. This also includes all members of a department with 30 or more emergency responders who are not the Fire Chief or a Chief Officer. Associate Members shall be entitled to participate fully in the affairs of the Association, with the exception of holding elected office and voting privileges. RETIRED ACTIVE MEMBERSHIP – Retired Active Membership shall include only Active Members who have retired from the Fire Service after ten (10) consecutive years, as members of the I.F.C.A. Retired Active Members shall be entitled to participate fully in the affairs of the Association, with exception of holding elective office. Retired Active Membership may be obtained by application to and certification from the Board of Directors. MEMBER SECTIONS DUES (CHECK – JOIN ANY OR ALL) ___ EMS………………………$ 25.00 ___ Public Safety Educator………$ 25.00 ___ Technical Rescue …..$ 25.00 ___ Aviation…………………..………$ 25.00 MEMBER DUES STRUCTURE AND PAYMENT METHODS Active Chief – First two (2) Chiefs (30 or more in Dept.) $ 75.00 each Additional Active Chief - (30 or more in Dept.) $ 50.00 each Member Dues ______ Departmental - Combo/Vol Dept. less than 30 $100.00 (please provide Dept. Roster) * attach roster list of members names Section Dues ______ Associate - Non Chief Rank (more than 30) or Interested Individuals $ 50.00 TOTAL DUES: $ _____ Retired Active (by approval) Free If an invoice is needed please complete application and indicate here with your initials_____ Check (payable to IFCA) # _____ Visa _____ MasterCard _____ Card Number: Expiration Date: Name On Card: Signature: Three Easy Ways To Join. Return application and payment: By Mail: IFCA Membership Application, P.O. Box 364, Zionsville, IN 46077 By Fax: 317-733-4212 Toll Free: 1-877-733-1850 Online: www.indfirechiefs.org E-Mail: firstname.lastname@example.org Sponsorship Opportunities Available – Please see our website at www.indfirechiefs.org or contact Terry Rake, IFCA Executive Director at 317-733-1850 or email@example.com.
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