Call Us 315-764-1744
Visit Us 341 E Orvis Street in Massena

Online Membership Application























Please indicate your availability to participate in normally scheduled rescue squad activities (meetings, drills, and emergency calls).




Previous emergency services experience: (include only fire, rescue, police, and emergency medical service agencies)













Please list three personal references, other than members of this organization, who have known you for at least three years.






















PRIVACY NOTIFICATION: Section 94 of the Public Officers Law (Personal Privacy Protection Law) requires that you be notified of the following facts when information which will be maintained in a record system is collected about you. The authority to request and confirm personal information about you is found in Article 6 of the Executive Law. The information obtained will:
- Be used to determine your qualifications for which you are applying;
- Be released to the President and your potential supervisors;
- Be maintained in your personnel file if you become a resque squad members, or in our resume file for six months if you are not a squad member



WITHIN THE FREEDOM OF INFORMATION LAW, ALL INFORMATION CONTAINED OR OBTAINED THROUGH THIS FORM WILL REMAIN CONFIDENTIAL AND WILL ONLY BE USED FOR INTERNAL MEMBERSHIP PROCESSING.



BY SUBMITTING THIS FORM YOU, THE APPLICANT, AFFIRM THAT ALL STATEMENTS MADE WITHIN ARE TRUE UNDER THE PENALTIES OF PERJURY.