Membership Application and Renewal Form



Individuals, families and corporate sponsors are invited to join the Nevada Fire Safe Council at the rates listed below. Memberships are renewed each January. Memberships paid from January 1, 2009 through September 30, 2009 are due for renewal in January 2010; memberships paid from October 1, 2009 through December 31, 2009 are due for renewal in January 2011. Payment of dues entitles each member to vote at the annual membership meeting.

To become a new member or renew your existing membership using a credit card please follow the instructions below.



*Required Field

Step 1: Select a Chapter to which you would like to belong. First select the state in which your property is located, then the region, then the chapter.

*


Step 2: Select a Membership level. Contributions in excess of $20 are considered charitable contributions and deductible to the fullest extent of the law.

Membership Type *Select One Dues Benefits                 Votes
Corporate Fire Safe $5000 Weblink, Newsletter, Hat, Shirt, Plaque 2
Gold $1000 Newsletter, Hat, Shirt 2
Silver $500 Newsletter, Hat, Shirt 2
Turquoise $100 Newsletter, Hat, Shirt 2
Crystal $50 Newsletter, Hat or Shirt 2
Family $20 Newsletter 2
Individual $10 Newsletter 1
Student, Senior, Disabled $5 Newsletter 1


Step 3: Enter the personal or organization information requested below.

*Applicant's Name:   (First)           (Last)
Organization Name:   (Please enter a contact name above for organizations.)
*E-Mail Address:  
*Area Code/Telephone:   ––
*Mailing Address:  
*Mailing City:  
*Mailing State:       *Zip Code:  
  Check here if your property address is same as mailing address, otherwise fill in below.
*Property Address:  
*Property City:  
*Property County:  
*Property State:       *Zip Code:  
Membership Dues:  $


Step 4: Select your choice of hat or shirt if you purchased a Crystal membership. Select a shirt size if your dues are $100 or more.

Choose Shirt or Hat:  


Step 5: Click the Continue button below to pay your membership dues using PayPal (no account necessary).
Important Note: Upon completing the payment process you must click the button on the PayPal confirmation page to complete your membership registration!