Ventura County Fire Department Historical Foundation
~ Remembering For The Future ~

Application for Membership

The Foundation is a private, non-profit, educational institution.

Our mission is to collect, preserve, display and tell the story of the
Ventura County Fire Department through interactive and engaging
exhibits at the Department Headquarters, libraries, in publications
and through educational programs.

Membership is an investment in the future.
~~~~~~
Please consider supporting the Foundation with your annual dues,
and if you wish, an additional contribution.

Thank you for your continuing support.

 Fields with an * are Required

 * Full Name  (and Nickname, if any):

 * Street Address:

 * Home Phone: (      )

 Would you be interested in serving on the Board of
 Directors?
                                    ______Yes      ______No

 * Email address, if possible:

 * City, State, Zip+4:

 Other Phone: (      )

 Would you be interested in volunteering your time
 in other ways?
                                       ______Yes      ______No

 Membership Descriptions:
 General - Includes those persons who are currently active or retired employees of the Ventura County Fire
 Protection District
 Associate - Includes those persons, associations, organizations, corporations or partnerships who are not
 classified as General Members; i.e., family, friends, history buffs, vendors, etc.

 * Membership Type/Payment Enclosed:
______  General$    10 Annual Dues
______  Associate$    10 Annual Dues
______  General LIFETIME$  100 LIFETIME Dues
______  Associate LIFETIME$  100 LIFETIME Dues

 I would also like to donate an additional sum$___________________

 * Total Enclosed$___________________

 Mail form with check made payable to:VCFD Historical Foundation
165 Durley Avenue
Camarillo, CA 93010-8586