Please fill out the on-line registration form below. You may also elect to simply print out the form and mail or fax it to our office in Sacramento.

After submitting this form, the following page WILL REQUIRE YOUR CREDIT CARD INFO. Do not submit this form if you do not plan to pay for your membership fees on-line. Please contact crainey@csfa.net if you have further questions about this form. You will receive an email from CSFA concerning access to this Web site.

Name:
Date of Birth:
For Calendar Year: 2011 2012 2013
Email Address:
Dept or School Name:
Last Year of Membership:

I am: Fulltime Paid Seasonal Volunteer or call Student

Position/Title:

County:

Department Class: Please Select... Volunteer Paid Combination NA - Student Applicant

Type Of Department: Please Select Fire District City County Tribal Department Other

Type of Membership: Please Select RETIRED LIFE EXPLORER STUDENT FIRST YEAR STUDENT SECOND YEAR STUDENT THIRD YEAR

If you have changed departments in the past year, please list your former department:

ATTENTION STUDENTS: You must submit copy of your student ID card or recent transcript with this application. You may fax a copy of either to (916) 446-9889 after you have completed these forms. Your membership will not be processed until a copy has been received. If you are currently a volunteer or paid firefighter with a department, you are NOT eligible for Student membership. Student membership is open to those who are strictly fire science students.

I choose NOT to have 1/10 of my dues allocated to the Firefighters' Legislative Action Group (FLAG) and used for the purposes as outlined in their constitution and by-laws. I understand that this allocation is voluntary.

I choose not to have any of portion of my dues allocated to CSFA PAC: