Membership Inquiry Form Membership Inquiry Form 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
