ESO Affiliate Membership Application Type(Required)– Select –New MembershipRenewal MembershipAffiliate Membership Fees(Required)– Select –One Year ($25)Annual membership period is January 1st through December 31st of calendar year. Affiliate is for Emergency Service Organizations (ESO) outside of Lancaster County, Pennsylvania.Emergency Service Organization (ESO)(Required)Station Number(Required)Organization Type(Required)Fire/RescueEMSOtherESO Phone Number(Required)ESO Mailing Address(Required) Street Address Address Line 2 City ALAKASAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPAPRRISCSDTNTXUTVIVTVAWAWVWIWYAAAEAP State ZIP Code Email Address for The Pennsylvania Fireman magazine(Required) Affiliate member organizations are entitled to a monthly digital edition subscription to The Pennsylvania Fireman magazine and a 5% discount on purchases from the LCFA Bookstore.ESO Officer InformationESO President Name(Required) First Middle Initial Last Suffix President Phone(Required)President Email(Required) ESO Secretary Name(Required) First Middle Initial Last Suffix Secretary Phone(Required)Secretary Email(Required) Consent(Required) I certify that I am authorized to submit this membership application and payment on behalf of the Emergency Service Organization listed above.Authorized Individual Submitting Application First Middle Initial Last Suffix Email Address of Authorized Individual(Required) Credit Card Convenience Fee Price: $0.00 Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Total Δ
