EMERALD SOCIETY  

          "FIREFIGHTERS OF WASHINGTON"

6/1/2007                                                  MEMBERSHIP APPLICATION

EXPIRATION DATE 3/17/20                                                                                             3 YEARS = $35

NAME________________________________________________________________DATE_________________________

ADDRESS___________________________________________________________________________________________

CITY___________________________________________STATE________ZIP+4____________________-__________

PHONE (Home) (_____)______________________________(Work)  (______)________________________________

SPOUSE'S NAME______________________________________________ ACTIVE         RETIRED         ASSOCIATE

E-MAIL ADDRESS_____________________________________________________

DIVISION____________COMPANY / STATION___________________PLATOON___________RANK____________

D.C.      NAT      NDW      PG     CHARLES      MONT      AA      HOWARD      ARL      ALEX      FAIRFAX    

STAFFORD      FT MYER      FT BELVOIR      FT MEADE      FALLS CHURCH      NAS-PAX RIVER      NIH     

OTHER FD________________________________________DATE RETIRED__________________________________

IF NOT DCFD:       FRIEND OF_______________________________________________________________________

Please mail $35 check & application to:

Emerald Society Membership

Douglas W. Wheeler

811 Kentucky Ave. SE

Washington DC 20003-3115

Doug@dcfireman.com

202-276-5081