ADFA Membership Form

Please provide the following information so that:

  1. ADFA will have information necessary to contact you; and,
  2. We may accurately represent you on the pay issues that are of concern to AD firefighters.

Fields marked with an asterix ( * ) must be completed.
*  First Name:
*  Last Name:
*  Retired:
 I have retired from a Federal, State, or Local agency.
 I am NOT retired from a Federal, State, or Local agency but work as an AD.
*  Email Address:
*  Mailing Address:
*  City:
*  State:
*  Zip Code:
*  Home Phone:
Business Phone:
Cell Phone:
Fax:
Company:
(if applicable)
*  Retired from Which Agency:
(if applicable)
*  Position at Retirement:
(if applicable)
Grade at Retirement:
(if applicable)
*  IQS Qualifications:
(please enter at least one)
1.
2.
3.
4.
Comments: