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 Julie.Cheline@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: 2014 2015 2016 Email Address: Dept or School Name: Last Year of Membership:
I am: Fulltime Paid Seasonal Volunteer or call Student
Department Class: Please Select...VolunteerPaidCombinationNA - Student Applicant
Type Of Department: Please SelectFire DistrictCityCountyTribal DepartmentOther
Type of Membership: Please SelectRETIRED LIFEEXPLORERSTUDENT FIRST YEARSTUDENT SECOND YEARSTUDENT THIRD YEAR
If you have changed departments in the past year, please list your former department:
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:
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