Date:  County you Work in Certification # Membership Active Associate

Last, First MI Email  

Students Home Address Apt. City

State Zip Home Tel# Work Tel# Ext Cell#

Your Title (s)  Would you like your name to be given out as an instructor? Yes No

List the courses that you are certified in teaching

Department/Business AffiliationVolunteer Career Combination

Department Address  City State Zip

Department Head Contact # Email Address

Is your department responsible for you annual membership dues? Yes No

Please list each class you would be interested in teaching

Please list any Comments

 Note:  Members receive IFSTA & Jones and Bartlett materials at a 10% discount, have use of our loaner library materials, access to our Annual Conference at  a discounted rate and receive information regarding the fire service via email.  The IFIA is constantly bringing new ideas to the organization, check the website regularly!  Membership dues are $20.00 annual