Fire Protection District Membership Form

INVOICE

For annual dues – 2010

According to our by-laws, members are REMOVED FROM THE ROLLS if dues remain unpaid after February 28

NOTE:   It is important that you provide at least one point of contact email address for your Fire Protection District.  The Missouri Association of Fire Protection Districts is attempting to go “paperless”, due to cost.  To receive the maximum benefit from your membership, we need at least one email address from you.  We would prefer to have those listed below if possible. Thank you in advance for your assistance.  

Fire District Name:___________________________________________

MailingAddress:_____________________________________________

City: ____________________________ Zip:  ______________________

Phone:___________________________Fax: _____________________

Point of Contact E-mail:  ____________________________________
   

Amount enclosed: $ __________________Check #:______________ 

Does Your Fire District have a Sales Tax?(Please check)

                                    □ Yes                □ No

The amount of your dues, which you needto return with this form, is shown on the chart on the next page.  If you have a Sales Tax, remember to add theSales Tax Surcharge of $300 to the total due.

Select the Type of Membership


 □          ACTIVE MEMBERSHIP – Any legallyorganized Fire Protection District meeting the requirements of Chapter 321 ofstate statutes may become an Active Member on paying the appropriate dues.  See chart below.


 □          TRIAL MEMBERSHIP – Any fire protectionassociation that is not located within the territory of an existing FireProtection District, and which is qualified as a “fire department” under statelaw.  A trial member is not required topay dues, and is not permitted to vote at MAFPD business meetings, nor may anyof its members hold office in the association. A trial member may continue in that category until it becomes a FireProtection District.   Free.


 □          ASSOCIATE MEMBERSHIP – Any person,firm, or corporation which provides services or products to Fire ProtectionDistricts may be eligible to be an Associate Member upon written application tothe Executive Director and the payment of dues. The Associate Members shall be entitled to such privileges, exceptholding elective office or voting, as the Board of Directors maydetermine.   $250.


 □          INDIVIDUALMEMBERSHIP– Individuals interested in promotingpublic fire safety, education or emergency medical services who do not qualifyas an Active Member, Trial Member, or Associate Member may become an IndividualMember upon approval of the Board of Governors and payment of dues.  The Individual Member shall be entitled to suchprivileges, except holding elective office and voting, as the Board maydetermine.  $150.


Membership Fee Structure, Active Members

Dues HAVE NOT Increased since l992,except for “Sales Tax Surcharge” added in 2007.  Dues are based primarily on your Assessed Valuation  (Remember, “Assessed valuation” is not the same as “appraised valuation” and is generally lower.  If you are uncertain about your assessedvaluation, check with your county clerk.)

Assessed Valuation                               Annual Dues                   
Below $10 million           .           .           Free            
$10 -- 25 million          .                         $  300            
$25 -- 50 million           .                        $  400            
$50 -- 100 million          .           .           $   500            
$100 -- 150 million        .           .           $   750            
$150 -- 200 million        .           .           $1,000            
$200 -- 300 million         .           .           $1,250            
$300-- 500 million          .           .           $1,500            
Over $500 million           .           .           $1,750

SURCHARGE, if your district has adopted a Sales Tax  + $300                                             


Please Provide Information at YourOfficers and Directors:(If you want us to send post office mail  only to your district address, you don’t need to give us a different mailing addresses for these peoples.  We would, however, appreciate receiving homephone number.)


BoardPresident/Chairman Name:
MailingAddress:                                                         
City/St/Zip: 
E-mail address:                                                           
Phone:                         Cell: 

BoardMember Name: 
MailingAddress:                                                         
City/St/Zip: 
E-mail address:                                                           
Phone:                         Cell:  

BoardMember Name: 
MailingAddress:                                                         
City/St/Zip: 
E-mail address:                                                          
Phone:                         Cell:  

BoardMember Name: 
MailingAddress:                                                         
City/St/Zip: 
E-mail address:                                                           
Phone:                         Cell:  

BoardMember Name: 
MailingAddress:                                                         
City/St/Zip: 
E-mail address:                                                           
Phone:                         Cell:  

FireChief Name: 
MailingAddress:                                                         
City/St/Zip: 
E-mail address:                                                           
Phone:                         Cell:  

FireDistrict Attorney Name: 
MailingAddress:                                                         
City/St/Zip: 
E-mail address:                                                           
Phone:                         Fax:  

THANK YOU FOR PROVIDING ALL THIS INFORMATION!  We know it may take extra time to fill outthis form, but the extra information allows us to serve you better. MAIL THIS FORM TOGETHER WITH YOUR CHECK, TO: MAFPD  5304 E. Tayside Circle, Columbia, MO 65203