Department Dues

"*" indicates required fields

Submitter Name

First Last

Submitter Email*

Submitter Phone

Fire Department Information

IVFA Department #*

Fire Dept Email Address

Fire Department Name*

Fire Department Mailing Address

Address City Zip

County

Township

Fire Department Physical Address (if different from above)

Address City Zip

County

Township

Fire Dept Office Phone

Meeting Day

Time

Type of Department

Volunteer

Combination

Career

Number of Volunteers

Number of Paid

Staff Information

Chief's Name

Chief's Email

Chief's Home Phone

Chief's Cell Phone

Secretary's Name

Secretary's Email

Secretary's Home Phone

Secretary's Cell Phone

Treasurer's Name

Treasurer's Email

Treasurer's Home Phone

Treasurer's Cell Phone

Roster Members

Renewing Members*

Member ID #

First Name

Last Name

Suffix

Member Type

Use the Plus Icon to add a row for each member.
Enter "NEW" into the Member ID # field if adding a new member
*in addition any new members will also require a signed application to be sent to the central office.

Remove Members

Member ID #

First Name

Last Name

Use the Plus Icon to add a row for each member

A 5% Service and Handling Fee will be added to the order total to cover processing and administrative expenses.

Subtotal

Price:

Service Fee

Price:

Total Amount Due

Credit Card

Cardholder Name

Card Details

Please only click Submit one time. It may take a few seconds to process your submission.

For Members

Department Dues

Fire Department Information

Staff Information

Roster Members