Membership Inquiry Form Membership Inquiry Form PLEASE NOTE THAT THIS IS A MEMBERSHIP INQUIRY FORM ONLY AND DOES NOT CONSTITUTE AN APPLICATION FOR MEMBERSHIP. YOU WILL BE CONTACTED BY SOMEONE FROM THE NEW MEMBER COMMITTEE TO DISCUSS THE APPLICATION PROCESS AND REQUIREMENTS. Name * First Name Last Name * Last Name Email * Phone * Birthdate * Age * Are you interested in applying to be a firefighter, EMT or both? * FirefighterEMTBoth Are you now or have you ever been a firefighter or EMT? * NoFirefighterEMTBoth Address 1 * Address 2 City * State * New York Zip * How many years have you been a resident of Nissequogue * If you are human, leave this field blank. Submit
