STATEWIDE
NOTIFICATION ASSOCIATION
P.O.
Membership
Application
To the board of Directors
General
Membership Fee $50.00
Commercial
Membership Fee $80.00
I
hereby apply for membership to Statewide New Hampshire Notification
Association, and declare that I am eighteen years of age or older.
I
am actively interested in the objectives of the association. I agree to abide
by all standard operating guidelines, which have been
explained to me by the board of directors, and/or have obtained a copy.
I will read them thoroughly when and if I am elected to membership. I
understand the standard operating guidelines may be revised from time to time,
and it is my duty to obtain an updated copy.
_______________________________________________________________________________________________________________________
As a member of the Statewide New Hampshire Notification
Association, I shall conduct myself in a professional, responsible and
courteous manner when representing the organization. I understand I am
responsible for the cost, maintenance and working order of any equipment used
while working on or with the Statewide System. I shall not hold Statewide or
any of its members liable for my actions associated with the organization. In
representing Statewide, I shall not present myself as an official emergency
responder or other official when at or near the scene of any incidents. I shall
not “Respond” to any incident. (I.e. use of emergency/warning lights and/or
sirens) I further understand that any actions or conduct detrimental to the
association will result in disciplinary action as dictated by the Statewide Board
of Directors. My signature below indicates full understanding of these
application requirements.
_________________________________________________________________________________________________________________________
Please
print clearly and sign below. Fill in
all applicable information
Print full Name
_______________________________________________________________________________
Residence/Home-Street Address________________________________ Apt #
_______________________________
Town/city___________________________
State_____________
Zip code________________________________
Home Telephone #_________________
Cell #_________________Nextel D/C # _____________________________
E Mail Address_______________________________________________________________________________
Occupation__________________________________________________________________________________
Business Address______________________________________________________________________________
Work Telephone #
_____________________________________________________________________________
Hobbies/Affiliations________________________________________________________________________________________
Amateur Radio (Ham) Operator Call Sign
________________________________________________________________________
Referral by Statewide Member: Yes ___ no___ Name of Member __________________________________________
Signature____________________________________________Date____________________________________
__________________________________________________________________________________________
For
official use only:
The representatives of this association believe the
above named applicant to be a desirable person to represent this association.
Elected__________ Denied_____________Reason_________________________________________________
Statewide New Hampshire Notification Association
Representative
Name______________________________Title___________________________________________________
Revised