MEMBERSHIP APPLICATION

 

Name                                                                                                                                                               

                            (Last)                                                              (First)                                                         (MI)

Address                                                              City                                         NY ___ Zip                              

 

Home Phone                                                       Other Phone                                                                           

 

E-Mail Address                                                                                                                                                 

 

Emergency Contact                                                                                                                                          

                                         (Name)                                            (Telephone)

                                                                                                                                                                       

Text Box: I, THE UNDERSIGNED, DO HEREBY APPLY FOR MEMBERSHIP IN THE NORTH GREENBUSH AMBULANCE ASSOCIATION, INC. I AGREE TO ACCEPT AND ABIDE BY THE BY-LAWS AND STANDARD OPERATING PROCEDURES AS SET FORTH BY THE ASSOCIATION
 

 

 

 

 

 

 

 
 
 


               ACTIVE 1 MEMBER 

                  Attend one (1) business meeting each quarter between November 1 and October 31, be assigned and active on the call sheet, attend the majority of regularly scheduled drills. If a member can not comply with any of these provisions, they must provide, in writing, an excuse to the Board of Directors to be acted on at their discretion. The member must possess a current AHA CPR card. The prospective member must complete an orientation program and a six (6) month probationary period.

 
 
 


                   

                ACTIVE SOCIAL     

  

                 A person who does not participate in emergency medical calls, but who actively lends their support to the Association. An active Social member is eligible to vote and run for civil office.

                                                                                                                                                                       

Application fee is Five ($5) and dollars and must accompany application.

 

SIGNED                                                                                      DATE                                                             

 

ENDORSED BY                                                                                                                                               

                                            (NGAA Member)                                                             (Member #)

RECOMMENDED BY                                                                                                                                        

                                            (NGAA Member)                                                             (Member #)

 

 

FOR ASSOCIATION USE ONLY                          $5 FEE RECEIVED

                                                            

Presented at meeting:             , 20                                   

Investigation / Chief:            , 20__              Yes      No

Voted on by Membership:               , 20__           By: __