DUtchess County Volunteer Firemen's Association
NAME___________________________________________________________________
ADDRESS________________________________________________________________
TOWN____________________________________________________________________
E-MAIL ADDRESS_________________________________________________________
FIRE DEPARTMENT_______________________________________________________
PROPOSED BY _____________________________________________________________
SIGNATURE_______________________________________________________________
REMIT $5.00 Member $ 10.00 Company
PLEASE FORWARD
TO
VINCENT GALVIN
8506
CHELSEA COVE NORTH
HOPEWELL JUNCTION, N.Y. 12533
E-MAIL CPCMAN79@AOL.COM