Membership Application

Thank you for your interest in becoming a volunteer with the Mt. Airy Volunteer Fire Company (MAVFC).  Please be sure to complete your application in its entirety before submitting.  Failure to complete the application will prolong the application process.  Before submitting your application, please be sure you have completed the following items:

• completed application
• four listed references, including valid email addresses
• **under the age of 18, must have parent/gaurdian permission (provide required contact information below)**
• uploaded training records or transcript if applicable
• $25.00 application fee will be collected upon submission of the application

 Once received, you will be contacted by me, the Fire Company's Financial Secretary, to review your application and answer any questions you might have. Your application will be reviewed by the Membership Committee, reference letters or emails will be sent to the references that you have provided, and you will be required to complete the background check with information that will be provided to you.  After all the required information has been gathered, the Committee makes the recommendation to the MAVFC membership and the membership makes the final determination.  The entire process generally takes between 4-8 weeks, depending upon the time elapsed to receive materials back.  (Notifying your listed references that they will be contacted typically speeds up the process!)  You will be notified via email on the disposition of your application.

If you have any further questions, please do not hesitate to contact me at (301) 829-0100, ext. 362 or e-mail at malexander@mavfc.org.

Sincerely,

Mary Alexander, Financial Secretary

Indicates Required Field

Name: Last Name, First Name, Middle Name
Address:
City, State, Zip:
Drivers License State:
Drivers License Expiration Date:
Drivers License Number:
Age:
Date Of Birth:
Cell Phone Number:
Other Phone Number:
Email Address:
Best way to contact you?:		Cell Phone Other Phone Email
Work/Volunteer History
Employer: Please list your current employer, if unemployed please type N/A
Current Position:
Years Employed:
Have you ever been a member of a Volunteer Fire Department:		Yes No
If yes, please list the name of the organization and how many years you were a member:
Firefighting and/or Emergency Medical Certifications:
Upload Certificates: Please provide copies of certifications:: Upload documents here: Acceptable formats include DOC, DOCX, PDF, XLS, XLSX, PPT, PPTX, TXT, JPEG, PNG		Add files...
What part of the organization are you interested in?: Please select all that apply.		Fire/Rescue EMS Fundraising Administrative
References
I acknowledge that you need at least 2 references returned to move forward :		Yes No
Reference 1 Name: First and Last Name
Reference 1 Information: Street Address City, State, Zip Phone Number and E-Mail
Reference 2 Name: First and Last Name
Reference 2 Information: Street Address City, State, Zip Phone Number and E-Mail
Reference 3 Name: First and Last Name
Reference 3 Information: Street Address City, State, Zip Phone Number and E-Mail
Reference 4 Name: First and Last Name
Reference 4 Information: Street Address City, State, Zip Phone Number and E-Mail
Criminal Information
Have you ever been convicted of, plead guilty to, or received probation before judgement for, a criminal offense?:		Yes No
Are any felony charges pending against you?:		Yes No
If Yes, please explain in detail.:
Additional Information
Why: Why did you decide to apply to the Mt. Airy Volunteer Fire Company and why do you think you would be a good member?
Acknowledgements
Electronic Signature:
**Parent/Guardian Information if Applicable:
Date Submitted:		05/17/2026 2239
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY.  The facts set forth in my application for membership are true and correct. I understand that a false statement on this application may be considered cause for rejection of this application or termination of my membership. I hereby authorize the Mt. Airy Volunteer Fire Company to conduct a work history, reference check, and/or police inquiries as it deems appropriate, and I further release the Mt. Airy Volunteer Fire Company of any circumstances that may come out of any investigations. (Note: any information retrieved will be kept confidential and treated as personal). I understand that nothing contained in the membership application promises anything regarding membership, and I understand that no such promise is binding upon the Mt. Airy Volunteer Fire Company unless made in writing. If accepted to the organization, I understand that I am a part of the Mt. Airy Volunteer Fire Company, and therefore I can be requested to resign or be terminated or expelled from membership. Causes for termination or expulsion from membership may include, but are not limited to:  Failure to comply with the bylaws of the organization  Failure to comply with the policies and procedures of the organization  Providing false or misleading information on this application By my electronic signature above, I affirm that I have read and understood these statements and I further agree to the provisions contained herein.