Fly Creek Volunteer Fire Company
P.O. Box 218
Fly Creek, NY 13337
Application for Membership
FIRST M.I. LAST
Social Security # _________________________________
Date of Birth ____________________________________
Driver License # __________________________________
1) Are you a resident of the Fly Creek Fire District? Yes No
2) Have you had any Fire or EMS training? Yes No
3) What interests do you have in the Fire Service?
(circle all that apply)
I hereby pledge to attend meetings, drills, fires, medical emergencies, etc. (when available).
I further pledge to follow all the Bylaws of the Fly Creek Volunteer Fire Company
and attend the mandatory training classes as required in the Bylaws.
Applicant’s Signature Date
NOTICE: New York State Law mandates that all applicants to a Volunteer Fire Service must submit to firefighter arson and
driver’s license background check before they can become a member of any Fire/EMS squad, department, company or service.