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Minnesota Wildland Firefighters’ Association Membership Application and National Emergency Wildfire Resource List Registration Form Name Last_________________________ First______________________ MI_________ Address City State____Zip________ Phone Day(____)_____-_______Night(____)_____-_______Other(____)_____-_______ Fax (____)_____-____________ Email address_________________________ Red card qualifications) 1)___________________________ Seasons___ (Print qualifications 2)___________________________ Seasons___ in order of preference and 3)___________________________ Seasons___ indicate seasons of 4)___________________________ Seasons___ experience for each 5)___________________________ Seasons___ skill/qualification) 6)___________________________ Seasons___ Total seasons of experience ____ Other skills/experience 1)___________________________ Seasons___ (example-Commercial drivers 2)___________________________ Seasons___ lisc.,EMT,etc.) 3)___________________________ Seasons___ Previous emergency/fire employers (optional) 1)____________________________________________________________ Seasons___ 2)____________________________________________________________ Seasons___ 3)____________________________________________________________ Seasons___ Are you interested in filling a position on a 20 person ground crew? y__n__ List Participants Each list participant will receive an ID code and a nationwide Toll free 800# which can be used to change their availability status as often as necessary. The list participants are required to notify the list administrator (via the Toll free 800#) whenever they will be unavailable for dispatch for any reason. Failure to do so may result in removal of their name from the NEWRL. (MWFA members receive a $10 discount on NEWRL registration.) __I am a MWFA member.(Membership #)_____________ __I wish to apply for MWFA membership. Signature_________________________________ Date_________ ----------------------------------------------------------------------------------------------------------------------- Cost of Membership(MWFA) and registration(NEWRL). MWFA membership-----------$5 through April 30. $10 after April 30. NEWRL registration-------$20 through April 30. $30 After April 30. Checks should be made out to MWFA and clearly indicate what they are for. Send form and fee/dues (check or Money order)to: MWFA/NEWRL c/o Dana Linscott,4731 Rockwood Ln. SW, Alexandria, MN 56308 DO NOT SEND CASH! Questions? Contact Dana Linscott at the address above or (email-linscott@rea-alp.com) Anyone who wishes can download, copy, and pass this out. Suggestions or questions...email me please. Thanks again, Dana Linscott Vice chair MWFA |
