East Greenbush Volunteer Fire Company, Inc.
68 Phillips Road Rensselaer, NY 12144
518-477-6503 ; 518-479-4168 Fax:518-477-2319
APPLICATION FOR MEMBERSHIP
A candidate for Active Membership whall be at least seventeen years of age and shall reside or be gainfully
employed within the territory of East Greenbush Fire District Number 3 or territory under contract with
East Greenbush Fire District Number 3.
~ Article 2, Section 2, Paragraph 1 of the East Greenubsh Fire Company Bylaws ~
Mailing Address Fields (leave blank if same as Present Address Above
Have you previously submitted an application
to the East Greenbush Fire Company?
If yes, please indicate the date::
Emergency Contact Name and Relationship:
Emergency Contact Address:
Emergency Contact Phone:
If you are employed within EGFD will your
employer allow you to leave work to respond to calls
Highest Grade Completed:
Degree Awarded or Credits Earned:
Military Service: If none, leave this section blank.
If yes, please explain: