Fire Department Membership Application

Department Profile

Fire Department Name*

FDID#*

Mailing Address*

Street Address City State ZIP Code

Same Address?

Same

Physical Address*

Street Address City State ZIP Code

County*

Other Counties Served

Station Telephone*

Administrative Contact*

First Last

Department Contact E-mail*

Department Website

Key Personnel

Fire Chief*

First Last

Email*

Cell Phone*

Deputy Chief

First Last

Email

Cell Phone

Assistant Chief(s)

Add

Assistant Chief*

First Last

Email*

Cell Phone*

Add

Assistant Chief*

First Last

Email*

Cell Phone*

Add

Assistant Chief*

First Last

Email*

Cell Phone*

Fire Department Structure

Type of Department*

County
Municipality
Special Purpose District (SPD)
Other

Staffing Type*

Career
Volunteer
Combination

ISO Rating*

Number of Stations*

Population Served*

Has the Fire Department signed the Statewide Mutual Aid Agreement?*

Yes
No

Type of Retirement System*

Police Officer Retirement System (PORS)
State Retirement System (SRS)
Other

Do you provide Workers Compensation for volunteers?*

Yes
No

Services

Please select all that your department provides:

First Responder
EMS Transport
High Level Rescue
Confined Space Rescue
Auto Extrication
Water Rescue
Haz Mat Response
Trench Rescue

Equipment

Number of Engines:*

Number of Aerial Devices:*

Number of Water Tenders (Tankers):*

Number of Ambulances:*

Number of Rescue Units:*

Number of Specialty Vehicles:*

Number of Brush Trucks:*

By submitting this form, you are officially requesting membership in the SC State Firefighters’ Association. The Association is a members benefit organization that will help your members reach full potential in training and safety while serving your community. This form will be presented to: first the Executive Committee, then the full membership during the annual Conference for approval, and then you will be notified of acceptance. Once accepted, you will be expected to complete an on-line roster of members and pay your annual dues before fully becoming a member department. The Association staff will help you through this entire process. Please call us if you have needs or questions at 800-277-2732.

Thank you for your desire for membership. You and your firefighters are important to us.