4170GOVERNMENT GAZETTE, WA 1 August 2017

4170 GOVERNMENT GAZETTE, WA 1 August 2017 Please list here any fire fighting equipment owned by you.

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4. ...................................................................................................................................................... ———— APPENDIX II APPLICATION FOR MEMBERSHIP—ASSOCIATE MEMBER I make application to be an associate member of the ..............................………………Bush Fire Brigade. (a) I am prepared to offer to transport fire fighting members and/or equipment to the scene of any outbreak when called upon. I have a motor vehicle of the following type ……………….. available for such purpose. MDL No: .......................................................... Classes: .......................................................... (b) I am prepared to offer my services in the following capacity— .......................................................................................................................................................... .......................................................................................................................................................... (paragraph (a) or (b) above may be struck out if not applicable) Applicant’s Name .......................................................................................................................................... My private address is .................................................................................................................................... ....................................................................................................................................................................... My business address is ................................................................................................................................. ....................................................................................................................................................................... Telephone No: (Home) ................................. (Work) .................................... Mobile ................................... Fax No: (Home) ............................................ (Work) ............................................... CB Radio ..................................... Channel .................................... Call Sign (2) to be governed by the provisions of the Bush Fires Act 1954 and any Regulations made under the Act and the local law and policies of the Shire of Northampton relevant to fire control and bush fire brigades; (3) to use my best endeavours to assist in normal bush fire brigade activities as an associate member when called upon; Date ............................................................. Applicant’s signature ................................................ ———— APPENDIX III APPLICATION FOR MEMBERSHIP—CADET MEMBER I make application to be a cadet member of the ........................................................... Bush Fire Brigade. Applicant’s Name .......................................................................................................................................... My private address is .................................................................................................................................... ....................................................................................................................................................................... Telephone No: (Home) ................................. (Work) ............................................... Fax No: (Home) .......................................................