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
DCVFA
392 Creek Road
Poughkeepsie,
Ny, 12601