DISASTER RESPONSE TEAM

              MEMBERSHIP APPLICATION

Disaster Response Team

Bev Marshall

PO Box 156

Brockwell, AR 72517

 

 

New Member: Address change/Other: Membership Renewal:

 

Name(Husband): FMCA Number:

Name(Wife):

Address:

City: State: Zip:

Phone: Cell Phone:

Email:

Do you have any Red Cross Certification?: Spouse?:

Would you be interested in attending some certification training classes with other members of the club?:

Do you have an Amateur Radio License?  Is so what is number :

Would you be interested in being a point of contact for your State or Area?

Do you have any other type of training or expertise that would be of benefit to the club?

Would you be willing to serve on a committee, or help with club activities?:

 

Birthdays Month & Day Only(Husband): (Wife):

Anniversary Month & Day Only:

 

I understand that neither this chapter of FMCA or FMCA National will provide insurance for a group of our chapter members while participating in a disaster clean-up.  Insurance will only be provided for a chapter meeting held in a campground or similar circumstances.  I agree to hold harmless FMCA National and FMCA Disaster Response Chapter.

Signature of Member :Signature of Spouse :

 

Annual Dues are $10.00 per year

Badges Pending at this time and will let you know when available and prices

T-Shirts are currently $10.00

Membership dues are not  refunded.

Chapter member must be FMCA members and maintain current a FMCA membership.

If not a member of FMCA go to there site for Application:  http://www.fmca.com

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