Contact us Today!

Use the form below to apply for membership to the Butler Township Volunteer Fire District. After completing this form, a representative of the membership committee will contact you. In the meantime, feel free to browse our website or visit our station to see what the Butler Township Volunteer Fire District is about.

Indicates Required Field

First Name:
MI:
Last Name:
Address:
Email Address:
Primary Phone:
Social Security #:
Date of Birth:
Area(s) of interest:		Firefighting Rescue Medical Social
Background Information
Previously a member of a fire department?:		Yes No
If yes, which one?:
Have you ever been convicted of a crime, other than a summary traffic violation?:		Yes No
If yes, please explain:
Has your driver's license ever been suspended?:		Yes No
If yes, when and why?:
Briefly state why you wish to join, what you expect of the department and what you expect to gain from membership.:
Administrative Data
In case of emergency notify: (Name, Phone Number, Relationship)
Three References, not related: (Name and Phone Number)
How did you hear about becoming a volunteer?:
Questions/Comments: